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Allergy to heparin: A new in vitro diagnostic technique

2003; Elsevier BV; Volume: 31; Issue: 6 Linguagem: Inglês

10.1016/s0301-0546(03)79206-4

1578-1267

M. Rosario Caballero, M. Fernández‐Benítez,

Venous Thromboembolism Diagnosis and Management

Few descriptions of allergic reactions to heparin have been published, because these reactions are not well known, their prevalence is low and they are difficult to diagnose due to the lack of an in vitro test until now. We propose a new technique, the basophil activation test (BAT) for the diagnosis of these reactions We performed in vivo and in vitro studies with heparin and its derivatives in two patients with heparin-induced acute urticaria. In both patients the results of prick tests with sodium and calcium heparin, enoxaparin and nadroparin with immediate reading were negative. Intradermal skin tests with immediate reading and reading at 48 and at 96 hours with calcium heparin, enoxaparin and nadroparin were positive in the immediate reading and after 48 hours in the first patient. The second patient showed positivity to nadroparin in the immediate reading. The same drugs were also tested using patch tests, with reading after 48 and 72 hours. The second patient showed positivity to nadroparin after 48 hours The BAT was positive to enoxaparin in the first patient and revealed showed slight positivity to sodium heparin in the second patient We consider the BAT to be a useful, safe and reliable test for the in vitro diagnosis of heparin allergy. This test avoids the use of provocation tests, which present a risk to the patient Las reacciones alérgicas frente a heparina se encuentran poco descritas en la bibliografía por su baja prevalencia, desconocimiento y dificultad que entraña su diagnóstico, debido a la inexistencia de pruebas in vitro hasta el momento. Proponemos una nueva técnica, el test de activación de basófilos (TAB), para su diagnóstico in vitro Realizamos estudio in vivo e in vitro frente a heparina y derivados, en dos pacientes con urticaria aguda en relación a este fármaco. Los resultado fueron: prueba cutánea prick con HNF (heparina sódica y cálcica) y con HBPM (enoxaparina y nadroparina) con lectura inmediata negativa, 2) pruebas intradérmicas con HNF (heparina cálcica) y HBPM con lectura inmediata, a las 48 h y a las 96 h, resultando positiva para el paciente 1 tanto la lectura inmediata como a las 48 h, la paciente 2 presentó positividad frente la nadroparina en lectura inmediata 3) pruebas epicutáneas con HNF y HBPM con lectura a las 48 y 72 h positiva a nadroparina a las 48 h en la paciente 2 paciente 1 positivo para nadroparina y en la paciente 2 débilmente positivo para heparina sódica Consideramos el TAB como un método útil, seguro y fiable para el diagnóstico in vitro de alergia a heparina, pudiendo evitar la realización de pruebas de provocación y con riesgo para el paciente