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Patients diagnosed with delayed-type hypersensitivity who experience skin inflammation following subcutaneous injection can safely withstand intravenous heparin infusion.
Exciting developments have emerged from a recent study published in 'The Journal of Allergy and Clinical Immunology' promising a safer and more effective approach to managing heparin allergies, potentially revolutionizing how this common medical issue is treated. Heparin allergies often lead to delayed-type hypersensitivity (DTH), causing itchy skin inflammation at the injection site. However, distinguishing these reactions from skin necrosis triggered by heparin-induced thrombocytopenia is critical.
Researchers Axel Trautmann, Franziska Grän, and Johanna Stoevesandt aimed to discover an alternative to heparin for anticoagulation, particularly in emergencies requiring immediate intravenous heparin administration when patients experience inflammatory skin reactions.
Over 17 years, the research team thoroughly examined all heparin DTH cases in their department. They subjected these cases to comprehensive allergy diagnostics, including challenge testing.
This involved administering a subcutaneous injection of Fondaparinux and an intravenous infusion of unfractionated heparin (UFH). As found, of the 50 patients with confirmed heparin allergies, 48 (96.0%) displayed DTH, whereas only 2 (4.0%) exhibited immediate-type hypersensitivity, presumably IgE-mediated. In the 48 DTH subjects, intradermal testing displayed substantial cross-reactivity between UFH and low-molecular-weight heparin (LMWH; for example, Dalteparin, Nadroparin, and Enoxaparin).
Also, cross-reactivity with or concurrent sensitization to Fondaparinux was observed in only 3 (6.3%) cases. Of note, 45 patients who underwent intravenous UFH challenge tolerated it, despite indicating DTH to both UFH and LMWH during intradermal testing. The use of intravenous UFH emerged as a safer alternative, while Fondaparinux appeared as a viable option for subcutaneous application.
Thus, if there is an inflammatory skin reaction at the area where heparin is injected under the skin, and there is no sign of skin tissue damage or low platelet count, using intravenous UFH appears to be a reasonably safe option, especially in emergency situations where immediate treatment is obligatory. Fondaparinux is the best alternative for administering under the skin in such cases. These findings introduce promising possibilities for treating heparin allergies, especially in emergency scenarios that demand swift action.
The Journal of Allergy and Clinical Immunology: In Practice
Delayed-Type Heparin Allergy: Intravenous Tolerance Despite Inflammatory Skin Reaction After Subcutaneous Injection
Axel Trautmann et al.
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