Heparins hypersensitivity reactions

Other adverse reactions include local irritation when heparin is given via the SC route. Hypersensitivity reactions may also occur with any route of administration and include fever, chills, and urticaria. More serious hypersensitivity reactions include an astiima-like reaction and an anaphylactoid reaction. 

It is also important that the nurse monitor for any indication of hypersensitivity reaction. The nurse reports reactions, such as chills, fever, or hives, to die primary health care provider. When heparin is given to prevent the formation of a thrombus, the nurse observes the patient for signs of thrombus formation every 2 to 4 hours. Because the signs and symptoms of dirombus formation vary and depend on the area or organ involved, die nurse should evaluate and report any complaint die patient may have or any change in die patient s condition to die primary health care provider. 

Hemorrhage is the main complication that can arise from heparin therapy. Other side effects include Heparin-Induced Thrombocytopenia Syndrome (HITS), local irritation, hypersensitivity reactions and with long-term use, alopecia, hypoaldoster-onism, and osteoporosis. 

Hypersensitivity reactions Heparin is derived from animal tissue use with caution in patients with a history of allergy. Before a therapeutic dose is given, a trial dose may be advisable. Have epinephrine 1 1000 immediately available. 

Hypersensitivity reactions and skin necrosis (similar to that seen with warfarin) occur but are rare. Transient alopecia has been ascribed to heparin but in fact may be due to the severity of the thromboembolic disease for which the drug was given. 

Erythematous nodules or infiltrated and sometimes eczema-hke plaques at the site of injection are common adverse effects of subcutaneous standard heparin 3-21 days after starting heparin treatment. They are probably delayed-type hypersensitivity reactions and are also seen with low molecular weight heparin (65-69). There can be cross-reactivity between standard heparin and low molecular weight heparin (69). 

Dux S, Pitlik S, Perry G, Rosenfeld JB. Hypersensitivity reaction to chlorbutol-preserved heparin. Lancet 1981 1(8212) 149. 

Dux S, Pitlik S, Perry G, Rosenfeld JB. Hypersensitivity reaction to chlorobutanol-preserved heparin [letter]. Lancet 1981 i 149. Itabashi A, Katayama S, Yamaji T. Hypersensitivity to chlorobutanol in DDAVP solution [letter]. Lancet 1982 i 108. 

When used systemically, notably in a heparin injection preserved with chlorocresol 0.15%, delayed irritant and hypersensitivity reactions attributed to chlorocresol have been reported. " " See also Section 19. 

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). 

An example of what can happen with raw materials that are insufficiently controlled by foreign authorities occurred in China with heparin. The raw material was intentionally adulterated with over-sulfated chondroi-tin sulfate (OSCS). Heparin injections prepared from this raw material in the United States have led to severe hypersensitivity reactions in patients [8]. The Ph. Eur. monograph has been revised with a test to detect this impurity, on recommendation of the EMA/CHMP assessment report about this topic [9]. In June 2013 the FDA issued a Note for Guidance for Industry about this subject to manufacturers taking steps to ensure that the heparin supply chain is not contaminated with OSCS [10]. 

Skin Of 320 patients, 24 (7.5% 95% Cl = 4.7, 11) had heparin-induced skin lesions, which were delayed-type hypersensitivity reactions in all cases [110 ]. The... 

In four patients with delayed hypersensitivity reactions to different forms of heparin, prick tests, intradermal tests, and patch tests were performed using unfractionated sodium heparin, low-molecular-weight heparins (nadroparin, enoxaparin, bemiparin, and dal-teparin), and fondaparinux [129 ]. There were different patterns of cross-reactivity all were sensitive to at least two forms of heparin and one patient was sensitive to all five drugs. 

Patients with a history of ICM-induced hypersensitivity should be tested in vivo and in vitro with the culprit ICM, and additional ICM 4 up to 6 weeks after they displayed the hypersensitivity reaction [13,26-28]. In addition, one should be aware that especially in patients undergoing radiological interventional procedures not only ICM but also a variety of other allergens (e.g. latex, heparins) may induce the observed hypersensitivity [29]. 

Koch P, Munssinger T, Rupp-John C, Uhl K. Delayed-type hypersensitivity skin reactions caused by subcutaneous unfractionated and low-molecular-weight heparins tolerance of a new recombinant hirudin. J Am Acad Dermatol 2000 42(4) 612-19. 

IgE, or immunoglobulin E, is associated with mast cells, which are basophils, a type of granular white blood cell that has left the bloodstream and entered a tissue. Mast cells release histamine and heparin, chemicals that mediate allergic reactions. Not surprisingly, IgE is responsible for immediate hypersensitivity (allergic) reactions and immune defense against parasites. 

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