Dermatite eczematosa in sede di inoculo di enoxaparina sodica: proposta di un protocollo di studio

The Authors describe a case of a 56-year-old woman who presented eczematous patches in the abdomen, in the sites of subcutaneous injection of enoxaparin sodium (fractionated heparin with low molecular weight). This therapy, introduced for recurrent thrombophlebitis of the right leg, was administered twice over the last 5 years. Skin allergodiagnostic tests confirmed the etiologic role of enoxaparin sodium and showed cross-reactions to nadroparin calcium (fractionated heparin with low molecular weight) and heparin calcium (unfractionated heparin). The challenge test with fondaparinux, fractionated heparin with very low molecular weight, was negative. We report and discuss the diagnostic protocol used by us for hypersensitivity reactions to heparins in order to clarify the causal role of offending heparin and to identify potential cross-reactions and, above all, alternative heparins.