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Heparins are important anticoagulants used in the prophylaxis and treatment of thromboembolic disorders [1]. They include unfractionated heparins (UFHs) and lowmolecular-weight heparins (LMWHs). Hypersensitivity reactions to LMWHs are not uncommon. Delayed-type hypersensitivity reactions are the most frequently reported [2]. Immediate reactions to UFH and LMWHs have also been reported [3]. Furthermore, these agents can trigger type 2 hypersensitivity reactions (thrombocytopenia) and type 3 reactions (Arthus reaction) [4]. Little is known about cross-reactivity between heparins; therefore, tolerance must always be demonstrated. Tolerance does not seem to depend on molecular weight [5]. Twenty-five patients with a history of hypersensitivity reactions to LMWHs were diagnosed with heparin hypersensitivity in our Allergy Department between 2013 and 2017. We recorded age, sex, clinical patterns, culprit drug, skin test results, and single-blind challenge tests (SBCTs) performed. We performed intradermal testing (IDT) with the culprit LMWH (Table), UFH, and a battery of LMWHs, using the same concentrations as that of the original undiluted drug. Readings were taken after 20 minutes and at 48 and 96 hours in the case of delayed reactions and after 20 minutes in immediate reactions. In delayed reactions, the SBCT was performed with LMWH (subcutaneous administration), and the therapeutic dose was reached in several days. In order to prove tolerance to UFHs, the drug was administered at increasing doses at intervals of 48 hours. On the first day, we administered 25% of the therapeutic dose, followed 60 minutes later by another 25% of the total dose. Fifty percent of the total dose was administered 48 hours later. The other 50% of the total dose was given 1 hour later (maximum 70 IU/kg, 5000 IU). Female sex, older age, and longer exposure to heparins seem to be risk factors for heparin allergy [6]. We found enoxaparin to be the most frequent heparin involved in delayed reactions (80.76%). Bemiparin was

Clinical Patterns of Heparin Allergy: Cross-reactivity Between Low-Molecular-Weight Heparins and Unfractionated Heparins