Anaphylactic reaction heparins

Protamine. Protamine, whose use to reverse heparin anticoagulation has increased over the last two decades, has also been incriminated. Reactions may involve a number of mechanisms including IgE, IgG and complement. The incidence of anaphylactic reactions is estimated at 0.19% (retrospective studies) and 0.69% (prospective studies), respectively [27]. 

The PMN cells include neutrophils, eosinophils, and basophils. Neutrophils make up 60-75% of circulating WBCs and provide the first line of defense against microbes that penetrate the normal barriers of skin. They are extremely efficient phagocytes and are a source of inflammatory cytokines and lipid mediators such as PGs, LTs, and platelet-activating factor. Eosinophils are involved in allergy and provide protection against parasites. Basophils contain vasoactive amines such as histamine, serotonin, and heparin, as well as precursors for PGs and LTs. Release of these pharmacological materials by the basophils is responsible for the anaphylactic reaction. These factors also serve as chemoattractants for neutrophils and eosinophils to sites of inflammation. 

Anaphylactic reactions to protamine and apro-tinin occur infrequently and anaphylaxis to latex has decreased markedly in recent years. The overall incidence of adverse reactions to heparin has been estimated at 0.2 % with heparin-induced thrombocytopenia, rare cases of anaphylaxis, a few delayed reactions, and some adverse skin reactions making up most of the reports. 

In the AN69ST membranes (Hospal, France), ca. 9 mg/m of the polycationic polymer poly(ethyleneimine) (PEI) is adsorbed by ionic interactions at the negatively charged sulfonate groups of AN69 PAN membranes to minimize the anaphylactic reactions associated with the negative charges at PAN membrane surface (see Section 18.5.3). No anaphylactic reactions have been reported with these modified membranes (Maheut and Lacour, 2001). Adverse reactions and heparin adsorption were only occasionally reported to occur (Lavaud et al., 2003). 

Greinacher A, Lubenow N, Eichler R Anaphylactic and anaphylactoid reactions associated with lepirudin in patients with heparin-induced thrombocytopenia. Circulation 2003 108 2062-2065. 

A wide range of allergic reactions have been described in patients receiving heparin, including urticaria, conjunctivitis, rhinitis, asthma, cyanosis, tachjrpnea, a feeling of oppression, fever, chUls, angioedema, and anaphylactic shock. 

As a result of the inhibitory effect of heparin on antibodies and anaphylaxis, allergic reactions are infrequent and true heparin sensitivity rare (one case of anaphylactic shock). Urticaria has been seen, induced by sensitivity to heparin s animal protein, and a histamine-like response at the injection site which gradually disappears if injections are maintained. 

Ungar, G. and Damgaard, E., Tissue reactions to anaphylactic and anaphylactoid stimuli proteolysis and release of histamine and heparin, J. Exp. Med. 101, 1 (1955). 

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