Ludwig Ralf J, Schindewolf Marc, Utikal Jochen, Lindhoff-Last Edelgard, Boehncke Wolf-Henning
Department of Dermatology, Clinic of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.
Thromb Haemost. 2006 Nov;96(5):611-7.
Localized hypersensitivity reactions to subcutaneous heparin injections have been described since 1952. Yet, the incidence of these reactions, which are distinct from skin lesions associated with heparin-induced thrombocytopenia type II (HIT II), remains uncertain. However, in the last 10 years an increasing number of patients have been reported, leading to the assumption that cutaneous hypersensitivity reactions towards heparin are underreported. Clinically patients present with itching, sometimes infiltrated, and blistering erythemas at the injection sites of heparins. The diagnosis of cutaneous heparin allergy may, on the one hand, lead to delay of required medical or surgical treatment. On the other hand, delayed initiation of treatment may lead to a generalized eczematous reaction. Hence, from review of 223 cases of patients with cutaneous hypersensitivity reactions to heparin, we here summarize the clinical picture of cutaneous type IV allergic reactions, define risk factors on both the patient- and drug-side, and give an overview of principle therapeutic alternatives, as well as recommendations for treatment options for emergency and elective patients. As the proposed management of patients with cutaneous hypersensitivity reactions to heparin may have fatal consequences when applied in patients with HIT type II, diagnosis of skin lesions in heparin-treated patients needs to be precise.
自1952年以来，皮下注射肝素引起的局部过敏反应已有相关描述。然而，这些反应的发生率与肝素诱导的血小板减少症II型（HIT II）相关的皮肤病变不同，目前仍不确定。然而，在过去10年中，报告的此类患者数量不断增加，这导致人们认为对肝素的皮肤过敏反应报告不足。临床上，患者在肝素注射部位出现瘙痒，有时伴有浸润性和水疱性红斑。皮肤肝素过敏的诊断一方面可能导致所需医疗或手术治疗的延迟。另一方面，治疗延迟可能导致全身性湿疹反应。因此，通过回顾223例对肝素发生皮肤过敏反应的患者，我们在此总结皮肤IV型过敏反应的临床表现，确定患者和药物方面的危险因素，并概述主要的治疗选择，以及针对急诊和择期患者的治疗方案建议。由于对肝素发生皮肤过敏反应患者的拟议管理方法应用于II型HIT患者时可能会产生致命后果，因此肝素治疗患者皮肤病变的诊断需要准确。
