Heparin allergic drug reactions

GAGs are classified into several major types based on the nature of the repeating disaccharide unit heparan sulfate, chondroitin sulfate, dermatan sulfate, keratan sulfate, and hyaluronan. A hypersulfated form of heparan sulfate called heparin, produced mostly by mast cells, plays a key role In allergic reactions. It is also used medically as an anticlotting drug because of its ability to activate a natural clotting inhibitor called antlthrombln III. 

Basophils are the least numerous and least well characterized of the circulating leukocytes. While they are not derived from the same progenitor cell as tissue mast cells, basophils and mast cells have several similar functions, including their participation in hypersensitivity reactions. Basophils have also been attributed roles in plasma lipolysis, parasite immunity, tumor cell cytotoxicity, and hemostasis. Increases have been associated with persistent lipemia, parasitism, allergic diseases, certain neoplastic diseases, and administration of certain drugs (e.g., heparin, penicillin). 

The main side-effect of heparin is bleeding. Because it has a shrrn duration of action (4-6 hours), bleeding can usually be controlled by Slopping the drug administration. If necessary, heparin can be neutralized by the intravenous injection of protamine, a basic jreplide ihai combines with the acidic heparin. Heparin occasionally causes allergic reactions and thrombocytopenia,... 

Drug contamination Adverse reactions to heparin contaminated with oversulfated chondroitin sulfate have been evaluated in a US case-control study of patients in dialysis facilities who had signs and symptoms of allergic reactions after 1 November 2007 [122 ]. There were 152 adverse reactions associated with heparin in 113 patients from 13 states from 19 November 2007 to 31 January 2008. The use of heparin manufactured by Baxter Healthcare was the factor most strongly associated with reactions, which occurred in 100% of 21 facilities in which cases were reported versus 4.3% of 23 control facilities. Vials of heparin manufactured by Baxter from facilities that reported reactions contained a contaminant identified as oversulfated chondroitin sulfate. Adverse reactions to the contaminated heparin were often characterized by hypotension, nausea, and shortness of breath within 30 minutes of administration. Of 130 reactions for which information on the heparin lot was available, 128 occurred in a facility that had contaminated heparin on the premises. Of 54 reactions for which the lot number of the heparin was known, 52 occurred after the administration of contaminated heparin. 

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