Allergy, Asthma and Immunology: Recurrent intradialytic heparin induced anaphylaxis: workup and management

Case Report

Open Access

Asia Pac Allergy. 2013 Oct;3(4):285-288. English. Published online 2013 October 31. http://dx.doi.org/10.5415/apallergy.2013.3.4.285
Copyright © 2013. Asia Pacific Association of Allergy, Asthma and Clinical Immunology.

Amelia Santosa,¹^,² Seng Hoe Tan,³ and Yew Kuang Cheng²^,³
¹Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore.
²Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
³Gleneagles Medical Centre, Singapore 258500, Singapore.
Correspondence: Cheng Yew Kuang. Gleneagles Medical Centre, 6 Napier Road #09-02 Singapore 258500, Singapore. Tel: +65-6474-9438, Fax: +65-6474-1847, Email: ykcheng@aar-clinic.com

Received August 07, 2013; Accepted September 30, 2013.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Heparin has been widely used for intradialytic anticoagulation since the 1940s. Heparin induced anaphylaxis can be life threatening, mandating early recognition and intervention. However, due to its relative rarity many physicians remain unaware. We report the case of a 70-year-old woman requiring dialysis, who developed recurrent anaphylaxis to intradialytic heparin. We describe a systematic approach to confirm the suspected heparin allergy, which must include an evaluation of predisposing factors, the dialysis equipment and concomitant medications. Further workup for safe alternatives employing skin prick and intradermal tests, as well as provocation tests are discussed.