Allergic anaphylaxis due to subcutaneously injected heparin

<p<Abstract</p< <p<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-...
Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Anders Diana [verfasserIn] Trautmann Axel [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2013

Schlagwörter:	Anaphylaxis Allergy Basophil activation test Enoxaparin Heparin Hypersensitivity Immunoglobulin E Immediate-type

Übergeordnetes Werk:	In: Allergy, Asthma & Clinical Immunology - BMC, 2011, 9(2013), 1, p 1
Übergeordnetes Werk:	volume:9 ; year:2013 ; number:1, p 1

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc Journal toc

DOI / URN:	10.1186/1710-1492-9-1

Katalog-ID:	DOAJ038977834

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allfields	10.1186/1710-1492-9-1 doi (DE-627)DOAJ038977834 (DE-599)DOAJf3476a7d3c434edc8212bed92822d800 DE-627 ger DE-627 rakwb eng RC581-607 Anders Diana verfasserin aut Allergic anaphylaxis due to subcutaneously injected heparin 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<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.</p< <p<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 <it<in-vitro</it< test method was negative. Furthermore, skin prick testing showed rather broad cross-reactivity among different heparin preparations tested.</p< <p<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.</p< Anaphylaxis Allergy Basophil activation test Enoxaparin Heparin Hypersensitivity Immunoglobulin E Immediate-type Immunologic diseases. Allergy Trautmann Axel verfasserin aut In Allergy, Asthma & Clinical Immunology BMC, 2011 9(2013), 1, p 1 (DE-627)512662487 (DE-600)2236671-4 17101492 nnns volume:9 year:2013 number:1, p 1 https://doi.org/10.1186/1710-1492-9-1 kostenfrei https://doaj.org/article/f3476a7d3c434edc8212bed92822d800 kostenfrei http://www.aacijournal.com/content/9/1/1 kostenfrei https://doaj.org/toc/1710-1484 Journal toc kostenfrei https://doaj.org/toc/1710-1492 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2013 1, p 1
spelling	10.1186/1710-1492-9-1 doi (DE-627)DOAJ038977834 (DE-599)DOAJf3476a7d3c434edc8212bed92822d800 DE-627 ger DE-627 rakwb eng RC581-607 Anders Diana verfasserin aut Allergic anaphylaxis due to subcutaneously injected heparin 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<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.</p< <p<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 <it<in-vitro</it< test method was negative. Furthermore, skin prick testing showed rather broad cross-reactivity among different heparin preparations tested.</p< <p<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.</p< Anaphylaxis Allergy Basophil activation test Enoxaparin Heparin Hypersensitivity Immunoglobulin E Immediate-type Immunologic diseases. Allergy Trautmann Axel verfasserin aut In Allergy, Asthma & Clinical Immunology BMC, 2011 9(2013), 1, p 1 (DE-627)512662487 (DE-600)2236671-4 17101492 nnns volume:9 year:2013 number:1, p 1 https://doi.org/10.1186/1710-1492-9-1 kostenfrei https://doaj.org/article/f3476a7d3c434edc8212bed92822d800 kostenfrei http://www.aacijournal.com/content/9/1/1 kostenfrei https://doaj.org/toc/1710-1484 Journal toc kostenfrei https://doaj.org/toc/1710-1492 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2013 1, p 1
allfields_unstemmed	10.1186/1710-1492-9-1 doi (DE-627)DOAJ038977834 (DE-599)DOAJf3476a7d3c434edc8212bed92822d800 DE-627 ger DE-627 rakwb eng RC581-607 Anders Diana verfasserin aut Allergic anaphylaxis due to subcutaneously injected heparin 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<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.</p< <p<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 <it<in-vitro</it< test method was negative. Furthermore, skin prick testing showed rather broad cross-reactivity among different heparin preparations tested.</p< <p<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.</p< Anaphylaxis Allergy Basophil activation test Enoxaparin Heparin Hypersensitivity Immunoglobulin E Immediate-type Immunologic diseases. Allergy Trautmann Axel verfasserin aut In Allergy, Asthma & Clinical Immunology BMC, 2011 9(2013), 1, p 1 (DE-627)512662487 (DE-600)2236671-4 17101492 nnns volume:9 year:2013 number:1, p 1 https://doi.org/10.1186/1710-1492-9-1 kostenfrei https://doaj.org/article/f3476a7d3c434edc8212bed92822d800 kostenfrei http://www.aacijournal.com/content/9/1/1 kostenfrei https://doaj.org/toc/1710-1484 Journal toc kostenfrei https://doaj.org/toc/1710-1492 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2013 1, p 1
allfieldsGer	10.1186/1710-1492-9-1 doi (DE-627)DOAJ038977834 (DE-599)DOAJf3476a7d3c434edc8212bed92822d800 DE-627 ger DE-627 rakwb eng RC581-607 Anders Diana verfasserin aut Allergic anaphylaxis due to subcutaneously injected heparin 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<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.</p< <p<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 <it<in-vitro</it< test method was negative. Furthermore, skin prick testing showed rather broad cross-reactivity among different heparin preparations tested.</p< <p<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.</p< Anaphylaxis Allergy Basophil activation test Enoxaparin Heparin Hypersensitivity Immunoglobulin E Immediate-type Immunologic diseases. Allergy Trautmann Axel verfasserin aut In Allergy, Asthma & Clinical Immunology BMC, 2011 9(2013), 1, p 1 (DE-627)512662487 (DE-600)2236671-4 17101492 nnns volume:9 year:2013 number:1, p 1 https://doi.org/10.1186/1710-1492-9-1 kostenfrei https://doaj.org/article/f3476a7d3c434edc8212bed92822d800 kostenfrei http://www.aacijournal.com/content/9/1/1 kostenfrei https://doaj.org/toc/1710-1484 Journal toc kostenfrei https://doaj.org/toc/1710-1492 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2013 1, p 1
allfieldsSound	10.1186/1710-1492-9-1 doi (DE-627)DOAJ038977834 (DE-599)DOAJf3476a7d3c434edc8212bed92822d800 DE-627 ger DE-627 rakwb eng RC581-607 Anders Diana verfasserin aut Allergic anaphylaxis due to subcutaneously injected heparin 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<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.</p< <p<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 <it<in-vitro</it< test method was negative. Furthermore, skin prick testing showed rather broad cross-reactivity among different heparin preparations tested.</p< <p<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.</p< Anaphylaxis Allergy Basophil activation test Enoxaparin Heparin Hypersensitivity Immunoglobulin E Immediate-type Immunologic diseases. Allergy Trautmann Axel verfasserin aut In Allergy, Asthma & Clinical Immunology BMC, 2011 9(2013), 1, p 1 (DE-627)512662487 (DE-600)2236671-4 17101492 nnns volume:9 year:2013 number:1, p 1 https://doi.org/10.1186/1710-1492-9-1 kostenfrei https://doaj.org/article/f3476a7d3c434edc8212bed92822d800 kostenfrei http://www.aacijournal.com/content/9/1/1 kostenfrei https://doaj.org/toc/1710-1484 Journal toc kostenfrei https://doaj.org/toc/1710-1492 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2013 1, p 1
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callnumber-first	R - Medicine
author	Anders Diana
spellingShingle	Anders Diana misc RC581-607 misc Anaphylaxis misc Allergy misc Basophil activation test misc Enoxaparin misc Heparin misc Hypersensitivity misc Immunoglobulin E misc Immediate-type misc Immunologic diseases. Allergy Allergic anaphylaxis due to subcutaneously injected heparin
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topic_title	RC581-607 Allergic anaphylaxis due to subcutaneously injected heparin Anaphylaxis Allergy Basophil activation test Enoxaparin Heparin Hypersensitivity Immunoglobulin E Immediate-type
topic	misc RC581-607 misc Anaphylaxis misc Allergy misc Basophil activation test misc Enoxaparin misc Heparin misc Hypersensitivity misc Immunoglobulin E misc Immediate-type misc Immunologic diseases. Allergy
topic_unstemmed	misc RC581-607 misc Anaphylaxis misc Allergy misc Basophil activation test misc Enoxaparin misc Heparin misc Hypersensitivity misc Immunoglobulin E misc Immediate-type misc Immunologic diseases. Allergy
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title	Allergic anaphylaxis due to subcutaneously injected heparin
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title_full	Allergic anaphylaxis due to subcutaneously injected heparin
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title_sort	allergic anaphylaxis due to subcutaneously injected heparin
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title_auth	Allergic anaphylaxis due to subcutaneously injected heparin
abstract	<p<Abstract</p< <p<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.</p< <p<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 <it<in-vitro</it< test method was negative. Furthermore, skin prick testing showed rather broad cross-reactivity among different heparin preparations tested.</p< <p<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.</p<
abstractGer	<p<Abstract</p< <p<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.</p< <p<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 <it<in-vitro</it< test method was negative. Furthermore, skin prick testing showed rather broad cross-reactivity among different heparin preparations tested.</p< <p<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.</p<
abstract_unstemmed	<p<Abstract</p< <p<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.</p< <p<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 <it<in-vitro</it< test method was negative. Furthermore, skin prick testing showed rather broad cross-reactivity among different heparin preparations tested.</p< <p<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.</p<
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Allergic anaphylaxis due to subcutaneously injected heparin

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