High incidence of heparin-induced allergic delayed-type hypersensitivity reactions in pregnancy Marc Schindewolf, MD, Corinna Gobst, MD, Hartmut Kroll,

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Presentation transcript:

High incidence of heparin-induced allergic delayed-type hypersensitivity reactions in pregnancy Marc Schindewolf, MD, Corinna Gobst, MD, Hartmut Kroll, MD, Andreas Recke, MD, Frank Louwen, MD, Manfred Wolter, MD, Roland Kaufmann, MD, Wolf-Henning Boehncke, MD, Edelgard Lindhoff-Last, MD, Ralf J. Ludwig, MD Journal of Allergy and Clinical Immunology Volume 132, Issue 1, Pages 131-139 (July 2013) DOI: 10.1016/j.jaci.2013.02.047 Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Study protocol. PF4, Platelet factor 4. Journal of Allergy and Clinical Immunology 2013 132, 131-139DOI: (10.1016/j.jaci.2013.02.047) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Clinical and histologic features of heparin-induced DTH reactions. A, Normal human skin. B-D, Hematoxylin and eosin–stained skin biopsy specimens from 3 patients with a DTH response to heparin. Fig 2, B, Very scant dermal leukocyte infiltration. Fig 2, C, Mostly perivascular dermal infiltration. Fig 2, D, Perivascular and perifollicular infiltration. E, Widespread red plaques with surrounding papules at enoxaparin injection sites on the abdomen and thigh. F, Localized, itching erythematous maculae to abdominal nadroparin exposure. Journal of Allergy and Clinical Immunology 2013 132, 131-139DOI: (10.1016/j.jaci.2013.02.047) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 A, Kaplan-Meier curve representing development of DTH reactions to heparin (straight line) during pregnancy and postpartum. Dashed lines represent 95% CI bands. B, Kaplan-Meier curves (straight lines) represent development of DTH reactions in response to individual LMWH preparations over time. Cox regression analysis revealed a higher DTH risk in nadroparin-treated patients compared with that in dalteparin-treated patients (HR, 26.7; 95% CI, 3.4-211.0; P = .00187) but not between enoxaparin- and dalteparin-treated patients (HR, 5.6; 95% CI, 0.3-96.1; P = .238). Small vertical lines in both graphs indicate observation periods defined by either DTH diagnosis or treatment cessation beginning on day 1 of treatment at any point during pregnancy. Journal of Allergy and Clinical Immunology 2013 132, 131-139DOI: (10.1016/j.jaci.2013.02.047) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions