title: Treatment of an acute flush reaction caused by subcutaneous r-hirudin with pegylated hirudin.
abstract: We report a patient who was treated with recombinant (r)-hirudin for heparin-induced thrombocytopenia and developed a flush reaction twice upon re-exposure to 25 mg of subcutaneous r-hirudin. Antihirudin IgG antibodies developed. The patient received 50 mg of PEG-hirudin subcutaneously over 2 days. No side-effects occurred. The level of IgG antihirudin antibodies increased. Ecarin clotting time and thrombin inhibition S2238 assay were not influenced by the patient's IgG antihirudin antibody. PEG-hirudin may be used in patients with intolerance to r-hirudin because of a dissociation of the allergenic and immunogenic properties of the pegylated drug.
authors.affiliation: 1st Department of Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, D-68167 Mannheim, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Harenberg
authors.forename: U
authors.initials: U
authors.lastname: Hoffmann
authors.forename: G
authors.initials: G
authors.lastname: Huhle
authors.forename: X H
authors.initials: XH
authors.lastname: Song
authors.forename: L C
authors.initials: LC
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000009:adverse effects*; D000991:Antithrombins / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005483:Flushing / Q000139:chemically induced / Q000188:drug therapy; D006493:Heparin / Q000009:adverse effects*; D024764:Hirudin Therapy; D006629:Hirudins / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000009:adverse effects; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D011994:Recombinant Proteins; C104614:polyethyleneglycol-hirudin; D006493:Heparin