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Saraiva S, Martins M, Sereno S, Ferreira P, Pinto A, Rasteiro C. Cutaneous hypersensitivity reaction to low molecular weight heparins in pregnancy, cross reactivity and prednisolone treatment: A case report. Obstet Med 2022. [DOI: 10.1177/1753495x221102709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In pregnant women, low molecular weight heparin is recommended as the preferred agent for venous thromboembolism prophylaxis and treatment. Despite their widespread application, heparin-induced skin lesions are probably under-reported and under-estimated. We present a case report of a primigravida treated with low molecular weight heparin for deep vein thrombosis, who developed a delayed-type hypersensitivity reaction to enoxaparin, tinzaparin and dalteparin. As the patient was pregnant, treatment options were restricted. Tolerance was achieved with dalteparin with adjuvant administration of prednisolone. An attempt to decrease prednisolone dose triggered delayed-type hypersensitivity reaction recurrence that was solved by keeping the initial prednisolone prescription. To the best of our knowledge, there are no described cases using this approach. In cases of delayed-type hypersensitivity reaction to low molecular weight heparin during pregnancy our case suggests that switching low molecular weight heparin and adjuvant administration of prednisolone can be an option.
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Affiliation(s)
- Susana Saraiva
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Matilde Martins
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Sara Sereno
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Patrícia Ferreira
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Augusta Pinto
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Cátia Rasteiro
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
- Faculdade de Ciências Médicas, Universidade da Beira Interior, Covilhã, Portugal
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Stingeni L, Bianchi L, Tramontana M, Pigatto PD, Patruno C, Corazza M, Foti C, Fabbrocini G, Micali G, Romita P, Napolitano M, Hansel K. Skin tests in the diagnosis of adverse drug reactions. GIORN ITAL DERMAT V 2020; 155:602-621. [DOI: 10.23736/s0392-0488.20.06698-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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3
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Assier H, Gener G, Chosidow O, Wolkenstein P, Ingen-Housz-Oro S. Acute generalized exanthematous pustulosis induced by enoxaparin: 2 cases. Contact Dermatitis 2020; 84:280-282. [PMID: 33131094 DOI: 10.1111/cod.13734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Haudrey Assier
- Department of Dermatology, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - Gwendeline Gener
- Department of Dermatology, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - Olivier Chosidow
- Department of Dermatology, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
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Osché M, Gusdorf L, Cribier B, Scrivener JN. Pustulose exanthématique aiguë localisée après injections d’héparine calcique. Ann Dermatol Venereol 2020; 147:207-211. [DOI: 10.1016/j.annder.2019.09.607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/14/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022]
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5
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Lobo Y, Robertson I, Stewart A, Rowe C. Enoxaparin‐induced bullous haemorrhagic dermatosis. Australas J Dermatol 2019; 61:e124-e125. [DOI: 10.1111/ajd.13159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yolanka Lobo
- Department of Dermatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Ivan Robertson
- Department of Dermatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Anne Stewart
- Department of Pathology Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Casey Rowe
- Department of Dermatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Translational Research Institute The University of Queensland Diamantina Institute Brisbane Queensland Australia
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Juricic Nahal D, Cegec I, Erdeljic Turk V, Makar Ausperger K, Kraljickovic I, Simic I. Hypersensitivity reactions to low molecular weight heparins: different patterns of cross-reactivity in 3 patients. Can J Physiol Pharmacol 2018; 96:428-432. [DOI: 10.1139/cjpp-2017-0246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Low molecular weight heparins (LMWHs) are used for a variety of indications. The most common type of hypersensitivity reactions to LMWHs are delayed-type hypersensitivity reactions (DHR). Immediate-type hypersensitivity reactions (IHR) occur only sporadically. Cross-reactivity of different LMWHs is a common and unpredictable problem. We present 2 cases of patients who developed DHR to nadroparin and enoxaparin, respectively. The third case presents a patient who developed IHR to nadroparin. Skin tests confirmed the hypersensitivity in all cases. In the cases of DHR, a skin test negative LMWH was identified and was tolerated in a challenge test. In the IHR case, cross-reactivity to all tested LMWHs was established. We hypothesize that the degree of cross-reactivity might depend on the type of hypersensitivity reaction with immediate reactions linked to more extensive cross-reactivity than delayed reactions. This is important to consider because, at least in some cases, a safe alternative LMWH can be identified.
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Affiliation(s)
- Danica Juricic Nahal
- Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
- Agency for Medicinal Products and Medical Devices of Croatia, Ksaverska cesta 4, 10000 Zagreb, Croatia
| | - Ivana Cegec
- Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Viktorija Erdeljic Turk
- Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Ksenija Makar Ausperger
- Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Iva Kraljickovic
- Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Iveta Simic
- Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
- University of Zagreb School of Medicine, Salata 3, 10000 Zagreb, Croatia
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Schindewolf M, Recke A, Zillikens D, Lindhoff-Last E, Ludwig RJ. Nadroparin carries a potentially high risk of inducing cutaneous delayed-type hypersensitivity responses. Contact Dermatitis 2017; 77:35-41. [DOI: 10.1111/cod.12764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Marc Schindewolf
- Division of Haemostaseology, Department of Internal Medicine; Goethe University Hospital; 60590 Frankfurt am Main Germany
- Division of Vascular Medicine, Swiss Cardiovascular Centre; University Hospital Bern; 3010 Bern Switzerland
| | - Andreas Recke
- Department of Dermatology and Lübeck Institute of Experimental Dermatology; University of Lübeck; 23538 Lübeck Germany
| | - Detlef Zillikens
- Department of Dermatology and Lübeck Institute of Experimental Dermatology; University of Lübeck; 23538 Lübeck Germany
| | - Edelgard Lindhoff-Last
- Division of Haemostaseology, Department of Internal Medicine; Goethe University Hospital; 60590 Frankfurt am Main Germany
- Agaplesion Bethanien Hospital, Cardiovascular Centre Bethanien (CCB); 60389 Frankfurt am Main Germany
| | - Ralf J. Ludwig
- Department of Dermatology and Lübeck Institute of Experimental Dermatology; University of Lübeck; 23538 Lübeck Germany
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Cesana P, Scherer K, Bircher AJ. Immediate Type Hypersensitivity to Heparins: Two Case Reports and a Review of the Literature. Int Arch Allergy Immunol 2017; 171:285-289. [DOI: 10.1159/000453525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/14/2016] [Indexed: 11/19/2022] Open
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Castellanos-González M, Velasco-Rodríguez D, Mancebo Plaza AB. Dermatosis ampollosa a distancia en pacientes tratados con heparina. Med Clin (Barc) 2016; 146:402-7. [DOI: 10.1016/j.medcli.2015.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
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10
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Tirofiban Combined with Fondaparinux for Post-PCI Treatment of Patients with Acute Coronary Syndrome and Mild Renal Insufficiency. Cell Biochem Biophys 2015; 73:603-7. [DOI: 10.1007/s12013-015-0580-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stadler S, Booken N, Schneider SW, Goerdt S, Klemke CD, Utikal J. Acid citrate dextrose extracorporeal photopheresis is an alternative treatment option for patients with heparin allergy. Int J Dermatol 2015; 54:e266-7. [PMID: 25784218 DOI: 10.1111/ijd.12789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/10/2014] [Accepted: 06/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Simone Stadler
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany.,Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nina Booken
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Stefan W Schneider
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Sergij Goerdt
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Claus-Detlev Klemke
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Jochen Utikal
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany. .,Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Étude de 19 cas d’allergie aux héparines prouvée par des tests cutanés. Ann Dermatol Venereol 2014; 141:23-9. [DOI: 10.1016/j.annder.2013.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/20/2013] [Accepted: 10/29/2013] [Indexed: 11/24/2022]
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13
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Hypersensibilité retardée aux héparines : diagnostic et prise en charge thérapeutique. Ann Dermatol Venereol 2012; 139:363-8. [DOI: 10.1016/j.annder.2012.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 01/09/2012] [Accepted: 01/31/2012] [Indexed: 11/24/2022]
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