Refine
Has Fulltext
- yes (12)
Is part of the Bibliography
- yes (12)
Document Type
- Journal article (12)
Language
- English (12) (remove)
Keywords
- Anaphylaxis (3)
- drug adverse reaction (3)
- drug allergy (3)
- drug hypersensitivity (3)
- allergy (2)
- anaphylaxis (2)
- penicillin allergy (2)
- penicillin hypersensitivity (2)
- urticaria (2)
- ACE inhibitor (1)
- Allergy (1)
- Basophil activation test (1)
- Beta-blocker (1)
- Double sensitization (1)
- Drug allergy (1)
- Drug reaction (1)
- Enoxaparin (1)
- Field sting (1)
- Heparin (1)
- Honey bee (1)
- Hymenoptera venom (1)
- Hypersensitivity (1)
- Immediate-type (1)
- Immunoglobulin E (1)
- Immunotherapy (1)
- Mastocytosis (1)
- Medizin (1)
- Non-steroidal anti-inflammatory drug (1)
- Pseudo-allergy (1)
- Relapse (1)
- Risk factor (1)
- Treatment failure (1)
- Vespula (1)
- age (1)
- agranulocytosis (1)
- algorithm (1)
- amoxicillin (1)
- ampicillin (1)
- angioedema (1)
- antibiotic (1)
- aspirin‐exacerbated respiratory disease (1)
- bee (1)
- brown band (1)
- buildup phase (1)
- drug exanthema (1)
- exanthem (1)
- fixed drug eruption (1)
- hereditary alpha-tryptasemia (1)
- hymenoptera (1)
- immunotherapy (1)
- leg cramps (1)
- macro-morphology (1)
- mastocytosis (1)
- micro-morphology (1)
- over-the-counter drugs (1)
- pediatric (1)
- pustular exanthema (1)
- quinine (1)
- risk factor (1)
- vespula (1)
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.