@article{AndersTrautmann2013,
  author    = {Anders, Diana and Trautmann, Axel},
  title     = {Allergic anaphylaxis due to subcutaneously injected heparin},
  series = {Allergy, Asthma \& Clinical Immunology},
  journal   = {Allergy, Asthma \& Clinical Immunology},
  doi       = {10.1186/1710-1492-9-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-96214},
  year      = {2013},
  abstract  = {Heparins are one of the most used class of anticoagulants in daily clinical practice. Despite their widespread application immune-mediated hypersensitivity reactions to heparins are rare. Among these, the delayed-type reactions to s.c. injected heparins are well-known usually presenting as circumscribed eczematous plaques at the injection sites. In contrast, potentially life-threatening systemic immediate-type anaphylactic reactions to heparins are extremely rare. Recently, some cases of non-allergic anaphylaxis could be attributed to undesirable heparin contaminants. A 43-year-old patient developed severe anaphylaxis symptoms within 5-10 minutes after s.c. injection of enoxaparin. Titrated skin prick testing with wheal and flare responses up to an enoxaparin dilution of 1:10.000 indicated a probable allergic mechanism of the enoxaparin-induced anaphylaxis. The basophil activation test as an additional in-vitro test method was negative. Furthermore, skin prick testing showed rather broad cross-reactivity among different heparin preparations tested. In the presented case, history, symptoms, and results of skin testing strongly suggested an IgE-mediated allergic hypersensitivity against different heparins. Therefore, as safe alternative anticoagulants the patient could receive beneath coumarins the hirudins or direct thrombin inhibitors. Because these compounds have a completely different molecular structure compared with the heparin-polysaccharides.},
  language  = {en}
}
@phdthesis{Oschatz2012,
  author    = {Oschatz, Chris Tina},
  title     = {Mechanisms and functions of the mast cell-activated contact system in inflammatory reactions},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-71539},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2012},
  abstract  = {SUMMARY Mast cell activation in allergic and inflammatory disease causes increased vascular permeability and edema. This thesis identifies a paracrine mechanism, by which heparin released from intracellular granules, is involved in mast cell-evoked alteration of endothelial barrier function in vivo. Negatively charged heparin initiated factor XII-driven contact activation. Activated factor XII triggered the formation of the inflammatory mediator bradykinin in plasma. Congenital deficiency and pharmacological targeting of factor XII and kinin B2 receptor provided protection from mast cell-heparin-induced leukocyte-endothelial adhesion and hypotension in rats and mice. Intravital laser scanning microscopy and tracer measurements showed that heparin increased leakage with fluid extravasation in skin microvessels in mice. Deficiency in factor XII or kinin B2 receptor conferred resistance to heparin-induced skin edema and largely protected mice from endothelial barrier dysfunction, caused by allergen-induced mast cell activation and anaphylactic reactions. In contrast, heparin and mast cell activation caused excessive edema formation in mice, deficient in the major inhibitor of factor XII, C1 esterase inhibitor. Hereditary angioedema patients, lacking C1 esterase inhibitor, suffered from allergeninduced edema. The data indicate that mast cell-heparin-initiated bradykinin formation plays a fundamental role in defective barrier function of pathological mast cell-mediated inflammation, hypotension and edema formation.},
  subject      = {Heparin},
  language  = {en}
}