Heparins anaphylaxis

Give protamine sulfate 1 mg/100 U heparin received in last 3 hours (give initial 10 mg test dose by slow IVP over 10 minutes and observe for anaphylaxis if stable give entire calculated dose by slow IVP maximum dose 100 mg)... 

Type I IgE Anaphylaxis, urticaria P-Lactam antibiotics penicillins (primarily), cephalosporins, carbapenems Non-fl-lactam antibiotics sulfonamides, vancomycin Others insulin, heparin... 

When given rapidly, protamine causes hypotension due to a decrease in vascular resistance, possibly linked to the release of nitric oxide from endothelium. Flypotension can be minimised by slow administration over 10-15 minutes. Protamine does not affect myocardial contractility. In some patients, systemic hypotension occurs in conjunction with pulmonary hypertension and, in severe cases, right ventricular failure. The mechanism is activation of the complement pathways by the heparin-protamine complex leading to release of thromboxane A2, which mediates pulmonary vasoconstriction. Unlike in anaphylaxis, plasma histamine concentrations are not increased. When this syndrome develops protamine administration should be stopped, and some have recommended giving heparin in an attempt to reduce the size of the heparin-protamine complex. 

Berkun Y, Haviv YS, Schwartz LB, Shaht M. Heparin-induced recurrent anaphylaxis. Qin Exp Allergy 2004 34(12) 1916-18. 

The results of a retrospective survey indicated that patients receiving isophane insulin, which contains protamine, were subject to an increased risk of severe reactions simulating anaphylaxis when protamine was used to reverse systemic heparinization after cardiac catheterization (Gray et al., 1985). 

The mediators released such as histamine, slow reacting substance of anaphylaxis (SRSA), serotonin and heparin cause a variety of physiological... 

Pituitary extracts contain some basic protein which may interfere with heparin. Although ACTH and heparin have similar effects on endocrine weight, body weight, protein metabolism, lipid metabolism, sludged blood, anaphylaxis, dispersibility phenomena, and peripheral eosinophilia , heparin prevents the eosinopenia and lymphopenia due to ACTH and corti-sone . It has no effect on the depletion of adrenal ascorbic acid by ACTH, sodium salicylate, adrenaline or histamine, or by cold exposure . In contrast, protamine blocks the depletion of adrenal ascorbic acid by ACTH. 

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. 

Drug-induced anaphylaxis is a relatively rare but life-threatening event [14]. It has been reported with protein-derived drugs (e.g., heparin, insulin), penicillin, curates, and miscellaneous drugs. 

Protamide LMFAB. See Lauramide DEA Protamide LNO. See Linoleamide DEA Protamide MEAA. See Acetamide MEA Protamide MRCA. See Myristamide DEA Protamide SA. See Stearamide DEA Protamide X-45-B. SeeCocamide DEA Protamine sulfate CAS 9009-65-8 53597-25-4 Synonyms Salmine sulfate Definition Mixt. of simple proteins obtained from the sperm or testes of certain species of fish has property of neutralizing heparin Toxicoiogy LD50 (IP, rat) 120 mg/kg, (IV, rat) 75 mg/kg, (subcut., mouse) 200 mg/kg poison by IP, IV, subcut. routes human systemic effects (anaphylaxis, blood pressure decrease, decreased urine vol.) TSCA listed Hazardous Decomp. Prods. Heated to decomp., emits very toxic fumes of NOx and SOx Uses Pharmaceuticals (parenterals, injectables)... 

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. 

Danaparoid and hirudins are chemically distinct from heparin and generally show little or no cross-reactivity in heparin-intolerant patients. Reported reactions to danaparoid include rash, pruritus, and reactions (some delayed) at the injection site. Figures of 0.015 and 0.16 % have been reported for anaphylaxis to hirudins on first and subsequent exposures, respectively. Urticaria and angioedema are other reported type I reactions. Fondaparinux selectively inhibits coagulation factor Xa and has a low allergenic potential. 

Heparin allergy, which caused a pruritic urticaria-like rash on the back in a 55-year-old man, without associated angioedema, wheezing, flushing, or anaphylaxis, has been successfully managed with an intravenous desensitization protocol (Table 1) [124 ]. Two earher protocols, which were used in a 34-year-old man [125 ] and a 55 year-old woman [126 ], are also shown in Table 1 for comparison. An even faster protocol has also been described [127 ]. A combined subcutaneous and intravenous protocol that was used in a 55-year-old woman is shown in Table 2 [128 ]. 

Mast cell A mast cell is derived from the myeloid stan cell and is part of the inunune system it contains many granules rich in histamine and heparin. Allhongh best known for their role in allergy and anaphylaxis, mast cells play an important protective role as well, being intimately involved in wound healing and defense against palhogens. 

---