Aspirin/heparins

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Aspirin/heparins Delayed-type hypersensitivity and intolerance: case report A 47-year-old woman with thrombophilia and recurrent deep vein thrombosis developed delayed hypersensitivity to enoxaparin sodium, nadroparin calcium and heparin, and was also intolerant of aspirin. The woman, who had a history of urticaria with aspirin and acenocoumarol, was switched from warfarin to enoxaparin sodium [Clexane; route and dosage not stated]. After 4 days, she had developed eczematous plaques at her injections sites, which persisted for several days [outcome not stated]. She was switched back to warfarin, but this was stopped 3 months later due to cholestasis, which was presumed to be drug-induced. Antiplatelet therapy was considered, and the woman underwent oral provocation with aspirin 1000mg, but she developed urticaria 7 hours after the last dose [dosages not clearly stated]. Desensitisation was unsuccessful [outcome not stated]. Intradermal testing with undiluted nadroparin calcium [Fraxparine; dosage not stated] led to an eczematous reaction within 3 days. At that time, the woman was admitted with deep vein thrombosis. Prick tests with heparin 5000IU/mL (10-1 and 10-2 dilutions) and dalteparin sodium were negative at 30 minutes, so she began receiving IV heparin (50IU bolus followed by 500IU), which was well tolerated. On day 4, she had developed eczema plaques only as local reactions with the intradermal test sites with nadroparin and heparin at 10-1 dilutions. She received topical steroids, and her lesions cleared. Heparin was continued for 3 days more. Author comment: "Failed ASA [aspirin] desensitisation in a patient with thrombophilia, ASA intolerance and delayed-type hypersensitivity reactions to heparins impaired thrombosis prophylaxis." Paunescu A. Delayed-type hypersensitivity to heparins and aspirin intolerance in a woman with thrombophilia. Allergy 66 (Suppl. 94): abstr. 1856, 27 Aug 2012. Available from: URL: http://onlinelibrary.wiley.com/doi/10.1111/ 803076369 j.1398-9995.2011.02650.x/pdf - Romania

0114-9954/10/1418-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Reactions 8 Sep 2012 No. 1418

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