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Thromb Haemost 2006; 96(05): 611-617
DOI: 10.1160/TH06-04-0210
Review Article
Schattauer GmbH

Management of cutaneous type IV hypersensitivity reactions induced by heparin

Ralf J. Ludwig
1   Department of Dermatology, Clinic of the J.W. Goethe University, Frankfurt am Main, Germany
2   pharmazentrum frankfurt / ZAFES, Clinic of the J.W. Goethe University, Frankfurt am Main, Germany
,
Marc Schindewolf
3   Department of Internal Medicine (Division of Vascular Medicine), Clinic of the J.W. Goethe University, Frankfurt am Main, Germany
,
Jochen Utikal
4   Department of Dermatology, Venerology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University Heidelberg, Mannheim, Germany
,
Edelgard Lindhoff-Last
3   Department of Internal Medicine (Division of Vascular Medicine), Clinic of the J.W. Goethe University, Frankfurt am Main, Germany
,
Wolf-Henning Boehncke
1   Department of Dermatology, Clinic of the J.W. Goethe University, Frankfurt am Main, Germany
› Author Affiliations
Further Information

Publication History

Received 14 April 2006

Accepted after resubmission 06 September 2006

Publication Date:
01 December 2017 (online)

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Summary

Localized hypersensitivity reactions to subcutaneous heparin injections have been described since 1952. Yet, the incidence of these reactions, which are distinct from skin lesions associated with heparin-induced thrombocytopenia type II (HIT II), remains uncertain. However, in the last 10 years an increasing number of patients have been reported, leading to the assumption that cutaneous hypersensitivity reactions towards heparin are underreported. Clinically patients present with itching, sometimes infiltrated, and blistering erythemas at the injection sites of heparins. The diagnosis of cutaneous heparin allergy may, on the one hand, lead to delay of required medical or surgical treatment. On the other hand, delayed initiation of treatment may lead to a generalized eczematous reaction. Hence, from review of 223 cases of patients with cutaneous hypersensitivity reactions to heparin, we here summarize the clinical picture of cutaneous type IV allergic reactions, define risk factors on both the patient- and drug-side, and give an overview of principle therapeutic alternatives, as well as recommendations for treatment options for emergency and elective patients. As the proposed management of patients with cutaneous hypersensitivity reactions to heparin may have fatal consequences when applied in patients with HIT type II, diagnosis of skin lesions in heparin-treated patients needs to be precise.

Keywords

Heparin - inflammation - pharmacology - allergy

Footnotes:

1 In this manuscript the term “heparin” refers to both unfractionated heparin (UFH) and low-molecular-weight heparins (LMWH).


2 Only those publications which clearly documented sensitization towards heparin by prick- patch- or i.e. in-vivo tests, or histological verification of CHS were included. Those, merely describing “skin lesions” after heparin administration or reporting “skin lesions” in the setting of immune heparin-induced thrombocytopenia were excluded from the analysis.


 

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