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Type IV hypersensitivity to subcutaneous heparin: a new case
M A Gonzalo Garijo1, F Revenga Arranz
1Allergology Department, Infanta Cristina University Hospital, Badajoz, Spain.
Journal of Investigational Allergology & Clinical Immunology
|November 1, 1996
Summary
This study confirms delayed-type hypersensitivity to heparin (H) and low molecular-weight heparin (LMWH). Skin reactions at injection sites indicate cross-reactivity between these anticoagulant treatments.
Area of Science:
- Dermatology
- Allergy and Immunology
- Pharmacology
Background:
- Low molecular-weight heparin (LMWH) like nadroparin calcium is widely used for anticoagulation.
- Previous exposure to unfractionated heparin (H) may predispose patients to reactions with LMWH.
Observation:
- A 71-year-old woman developed pruritic skin lesions at nadroparin injection sites.
- Biopsy revealed spongiosis and a superficial perivascular infiltrate with lymphocytes and eosinophils.
- Re-challenge with nadroparin induced similar lesions, confirming hypersensitivity.
Findings:
- Epicutaneous and intradermal tests demonstrated delayed-type hypersensitivity to both unfractionated heparin and LMWH.
- Patch tests showed persistent erythematous reactions to all tested heparins.
- Intradermal testing elicited infiltrated, erythematous plaques with vesicles, indicative of a delayed hypersensitivity reaction.
Implications:
- These findings highlight the potential for delayed-type hypersensitivity and cross-reactivity between unfractionated heparin and LMWH.
- Clinicians should consider hypersensitivity reactions in patients developing skin lesions after heparin administration.
- Further investigation into the immunological mechanisms underlying heparin hypersensitivity is warranted.