TY - JOUR
T1 - Diagnosis of heparin-induced delayed type hypersensitivity
AU - Schindewolf, M.
AU - Ludwig, Ralf J.
AU - Wolter, M.
AU - Hardt, K.
AU - Kaufmann, R.
AU - Lindhoff-Last, E.
AU - Boehncke, W. H.
AU - Kahle, B.
PY - 2010/10/8
Y1 - 2010/10/8
N2 - Heparin is commonly used for prevention and therapy of thromboembolic diseases. Recently, work from a prospective epidemiological investigation has indicated, that heparininduced skin lesions may be more frequent, than expected. Commonly, delayed-type hypersensitivity reactions can be identified as the cause of heparin-induced skin lesions. Rarely, immediatetype hypersensitivity responses or immune-mediated heparin-induced thrombocytopenia (HIT) are diagnosed. It is of clinical importance to differentiate between those, as patient management is fundamentally different. Patients, methods: We evaluated diagnostic procedures used to identify causes of heparin-induced skin lesions. Based on clinical presentation, histology and/or allergologic testing in 32 patients, heparin-induced delayed-type hypersensitivity (HIHS) was diagnosed. Results: Sensitivity of histology and s.c. provocation was high, amounting to 100% or 78% respectively. All other tests were unspecific or had a low sensitivity: Immediate readings of prick tests were false negative in 81%. Patch, prick and i.c. testing had a sensitivity ranging from 3.1-15.6%. Conclusion: Based on these results and despite the limitations of histology we recommend performing a skin biopsy rather than allergologic testing for diagnosis of HIHS. Compared to allergologic testing, results from histology are sensitive, readily available and may allow a differentiation from other causes of heparin-induced skin lesions.
AB - Heparin is commonly used for prevention and therapy of thromboembolic diseases. Recently, work from a prospective epidemiological investigation has indicated, that heparininduced skin lesions may be more frequent, than expected. Commonly, delayed-type hypersensitivity reactions can be identified as the cause of heparin-induced skin lesions. Rarely, immediatetype hypersensitivity responses or immune-mediated heparin-induced thrombocytopenia (HIT) are diagnosed. It is of clinical importance to differentiate between those, as patient management is fundamentally different. Patients, methods: We evaluated diagnostic procedures used to identify causes of heparin-induced skin lesions. Based on clinical presentation, histology and/or allergologic testing in 32 patients, heparin-induced delayed-type hypersensitivity (HIHS) was diagnosed. Results: Sensitivity of histology and s.c. provocation was high, amounting to 100% or 78% respectively. All other tests were unspecific or had a low sensitivity: Immediate readings of prick tests were false negative in 81%. Patch, prick and i.c. testing had a sensitivity ranging from 3.1-15.6%. Conclusion: Based on these results and despite the limitations of histology we recommend performing a skin biopsy rather than allergologic testing for diagnosis of HIHS. Compared to allergologic testing, results from histology are sensitive, readily available and may allow a differentiation from other causes of heparin-induced skin lesions.
UR - http://www.scopus.com/inward/record.url?scp=77957345648&partnerID=8YFLogxK
M3 - Journal articles
AN - SCOPUS:77957345648
SN - 0939-978X
VL - 39
SP - 226
EP - 231
JO - Phlebologie
JF - Phlebologie
IS - 4
ER -