title: Recurrent intradialytic heparin induced anaphylaxis: workup and management.
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.
authors.affiliation: Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore. ; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
authors.forename: Amelia
authors.initials: A
authors.lastname: Santosa
authors.forename: Seng Hoe
authors.initials: SH
authors.lastname: Tan
authors.forename: Yew Kuang
authors.initials: YK
authors.lastname: Cheng
keywords: Anaphylaxis; Dialysis; Drug hypersensitivity; Heparin; Intradermal test; Skin tests