Delayed hypersensitivity to new oral anticoagulants. Demonstration of cross reactivity for the drug category and definition of non-irritant concentrations for patch tests
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Authors Information
1 Internal Medicine Department, Allergy Unit, Rimini Hospital, Rimini, Italy
2 Pharmacy Unit, Ravenna Hospital, Ravenna, Italy
3 Pharmacy Unit, Rimini Hospital, Rimini, Italy
History
Published online: 31 July 2018
Accepted: 9 July 2018
Received: 17 April 2018
SUMMARY
The current therapy with direct trombin inhibitors (DTI) is indicated for the prevention of stroke in non-valvular atrial fibrillation. Side effects are reported, particularly skin hypersensitivity, for this whole category of drugs as well as for other modern antiplatelet and anticoagulant drugs.
For their clinical features, these reactions appear as delayed T-cell mediated drug hypersensitivity, but at present there are no diagnostic methods of investigation. We reported a case of delayed skin reaction to edoxaban and we found the non-irritant concentration for patch test in the whole category of drugs.
The patch test resulted positive for edoxaban. A successive challenge with alternative DTIs and/or a switch to warfarin is proposed as alternative therapy.
