PROGRAMM JAHRESTAGUNG 2012 30. Nov. – 2. Dez ... - ÖGDV

Poster Allergologie und Immunologie
P 7
Diagnosis and cross-reactivity patterns in DTH reactions to LMWH
T. Kinaciyan 1
K. Syre 1
S. Wöhrl 1
G. Stingl 1
E. Jensen-Jarolim 2,3
1 Medical University of Vienna, Div. of Immunology, Allergy & Infect. Diseases, DIAID,
Department of Dermatology, Vienna, Austria
2 University of Veterinary Medicine Vienna, Medical University of Vienna and the
University of Vienna, Messerli Research Institute, Vienna, Austria
3 Medical University of Vienna, Department of Pathophysiology and Allergy Research,
Vienna, Austria
Background: Heparins, low molecular weight heparins (=LMWH), heparinoids and
hirudin are frequently used anticoagualtives. Especially LMWH are known to often cause
localized delayed type hypersensitivity reactions (DTHR) at the injection site and to
frequently cross-react among each other.
Methods: In this study, we retrospectively analysed data of 52 patients introduced to
our outpatient clinic in the past 11 years for diagnostic evaluation of current or past
hypersensitivty reactions after using LMWH. Data was evaluated regarding the culprit
drug/s, type of reaction, age, gender, atopy and other risk factors. Further, the skin and
provocation test results were reviewed for their clinical relevance and reliability.
Results: Enoxaparin was the most common causative LMWH for localized DTHR,
followed by Dalteparin. Intradermal tests with late reading were twice as much sensitive
as patch testing and resulted positive in 41% for Enoxaparin and 32% for Deltaparin.
The most commonly cross-sensitivity pattern was between Enoxaparin and Dalteparin.
Those two participated together at different patterns of cross-reactivity in 61,54%. In
34,62% each the following triple-combinations also appeared in different patterns of
cross-reactivity: Enoxaparin, Dalteparin and Danaparoid and Enoxaparin, Dalteparin
and Nadroparin. In 2 patients a cross-reactivity between 6 tested praparations were
found, in 3 cases cross-reactivity extended over 5, in 9 over 4 in 5 over 3 and in another
5 cases over 2 LMWH. Monosensitivity was found only in 3 cases. 84,6% of the patients
were women, there was a significant difference in gender regarding DTHR or
cross-reactivity in LMWH. In men only in 25% a cross-reactivity against two or more
LMWH has been detected whereas in women in 50%. No patients suffered from an
atopic dermatitis, 38,5% showed another atopic disease or had an atopic predisposition,
pregnancy may be a risk factor in 2 of our patients, in one of those an allergy could be
excluded.
Conclusions: Our data suggest that female gender, advanced age are not only risk
factors for localized DTHR to LMWH but also for higher frequency and amount of
cross-reactivity. Enoxaparin was the most common LMWH and cross-reacted most
frequently with Deltaparin followed by Danaparoid, a heparinoid, that was used as an
alternative earlier. The very extensive cross-reactivity in some patients makes it difficult
to find an individual safe alternative.
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