Delayed-type hypersensitivity to heparin: From diagnosis to management

作者：Lefevre S^*; Pinazo A; Castellano A; Oster J P

来源：Revue Francaise d'Allergologie, 2015, 55(2): 78-82.

DOI：10.1016/j.reval.2014.10.007

• Heparin
• Allergy
• Delayed-type hypersensitivity
• Cross-reactivity
• Fondaparinux
• NOAC

Heparin, widely used in the prophylaxis and treatment of thromboembolic disorders, are sometimes responsible for delayed-type hypersensitivity skin reactions. These reactions, affecting 7.5% of patients cause both diagnostic and therapeutic issue, because in most cages, anticoagulation treatment responsible must be substituted with a major risk of cross-reactivity up to 80% depending on the type of heparin used. After eliminating an heparin-induced thrombocytopenia, the physician has then to choose another treatment, fondaparinux being first-line alternative, despite the risk of cross-reactivity of 10.4%. Considering these substantial risks, novel oral anticoagulants (NOACs) will, in some cases, another treatment option than fondaparinux. The immuno-allergological work-up, based on skin allergy tests, are reserved to reciding patients with fondaparinux, due to unknown sensitivity and specificity, and the potential risk of new sensitizations. In the latter case, the use of unfractionated heparin, danaparoid or hirudin is justified.

• 出版日期2015-4