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Association of heparin-induced skin lesions, intracutaneous tests, and heparin-induced IgG

Background: Cutaneous heparin-induced allergic reactions to subcutaneous heparin may begin 2-5 days after administration. The relation of the delayed-type hypersensitivity and a systemic immunologic response is controversial. The present investigation aimed to analyze the occurrence of thromboemboli...

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Hauptverfasser: Harenberg, Job (VerfasserIn) , Huhle, Günter (VerfasserIn) , Wang, Lianchun (VerfasserIn) , Hoffmann, Ursula (VerfasserIn) , Bayerl, Christiane (VerfasserIn) , Kerowgan, Mohammed (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 1999
In: Allergy
Year: 1999, Jahrgang: 54, Heft: 5, Pages: 473-477
ISSN:1398-9995
DOI:10.1034/j.1398-9995.1999.00048.x
Online-Zugang:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1034/j.1398-9995.1999.00048.x
Verlag, lizenzpflichtig, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1034/j.1398-9995.1999.00048.x
Volltext
Verfasserangaben:J Harenberg, G Huhle, L Wang, U Hoffmann, Ch Bayerl, M Kerowgan

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520 |a Background: Cutaneous heparin-induced allergic reactions to subcutaneous heparin may begin 2-5 days after administration. The relation of the delayed-type hypersensitivity and a systemic immunologic response is controversial. The present investigation aimed to analyze the occurrence of thromboembolic complication, pathologic heparin-induced platelet activation (HIPA), and the presence of circulating heparin-induced IgG in patients with heparin-induced skin reactions. Methods: Intracutaneous tests, HIPA assay, and heparin-heparin IgG antibodies were performed in nine patients with heparin-induced skin lesions. Results: Six of eight patients showed positive intracutaneous tests to heparin and to four low-molecular-weight heparins. Three of six heparin-positive patients presented hypersensitivity to a heparinoid, too. Two of three patients had a positive HIPA test and elevated heparin-induced IgG antibodies. Both patients developed complications presenting as heparin-induced skin necrosis or arterial thrombosis. Two of nine patients were treated with danaparoid, 4/9 patients received r-hirudin, and 1/9 received oral coumarin. In 2/9 patients, anticoagulant therapy was stopped, but these patients will receive r-hirudin if indicated. Conclusions: On the basis of the coincidence of local and systemic hyperreactivity to heparin and danaparoid, patients with heparin-induced skin lesions should receive r-hirudin, a nonheparin compound, for anticoagulant treatment. 
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