Allergy, Asthma and Immunology: Oral antiplatelet agent hypersensitivity and cross-reactivity managed by successful desensitisation

February 11, 2015

Oral antiplatelet agent hypersensitivity and cross-reactivity managed by successful desensitisation

2015 Jan;5(1):51-4. doi: 10.5415/apallergy.2015.5.1.51. Epub 2015 Jan 28.

Chin N1, Rangamuwa K1, Mariasoosai R1, Carnes J1, Thien F2.

Author information

1Department of Respiratory Medicine, Eastern Health, Melbourne, Victoria 3128, Australia.
2Department of Respiratory Medicine, Eastern Health, Melbourne, Victoria 3128, Australia. ; Professor of Respiratory Medicine, Allergy and Immunology, Monash University, Melbourne, Victoria 3145, Australia.

Abstract

Oral platelet aggregation inhibitors are widely used for the treatment and prevention of cardiovascular diseases, including coronary stent thrombosis. Premature discontinuation following percutaneous coronary intervention would pose a grave risk of in-stent thrombosis, acute myocardial infarction and eventual death.

Although they share the same mechanism of adenosine diphosphate P2Y12 platelet receptor inhibition, they belong to either the chemical class of thienopyridines (clopidogrel, prasugrel, and ticlopidine) or cyclopentyl-triazolo-pyrimidines (ticagrelor and cangrelor). This case describes the first documented cross-reactive hypersensitivity of clopidogrel towards both its fellow thienopyridine, prasugrel, as well as the structurally dissimilar ticagrelor, and its subsequent successful desensitisation.