Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management

Rampton, David; Folkersen, Joergen; Fishbane, Steven; Hedenus, Michael; Howaldt, Stefanie; Locatelli, Francesco; Patni, Shalini; Szebeni, János; Weiss, Günter

doi:10.3324/haematol.2014.111492

Cited by 251 publications

(279 citation statements)

References 29 publications

Supporting

Mentioning

251

Contrasting

Unclassified

Order By: Relevance

“…Such minor infusion reactions occur roughly in 1:200 administrations [102], and resolve quickly by simply stopping the infusion without the need of any other treatment. Of note, there is increasing consensus on avoiding anti-histaminic drugs in such conditions, with particular reference to diphenhydramine, as it could determine hypotension and other unwanted side effects, leading to paradoxical aggravation rather than amelioration of the clinical picture [49,103]. More serious "anaphylactoid" reactions, including hemodynamic and respiratory changes, can also occur with virtually all IV iron preparations, including the newer ones (see below), but appear exceedingly rare (see below).…”

Section: The Chemistry Of Different IV Iron Preparations and Its Relamentioning

confidence: 99%

Modern iron replacement therapy: clinical and pathophysiological insights

et al. 2017

View full text Add to dashboard Cite

Iron deficiency, with or without anemia, is extremely frequent worldwide, representing a major public health problem. Iron replacement therapy dates back to the seventeenth century, and has progressed relatively slowly until recently. Both oral and intravenous traditional iron formulations are known to be far from ideal, mainly because of tolerability and safety issues, respectively. At the beginning of this century, the discovery of hepcidin/ferroportin axis has represented a turning point in the knowledge of the pathophysiology of iron metabolism disorders, ushering a new era. In the meantime, advances in the pharmaceutical technologies are producing newer iron formulations aimed at minimizing the problems inherent with traditional approaches. The pharmacokinetic of oral and parenteral iron is substantially different, and diversities have become even clearer in light of the hepcidin master role in regulating systemic iron homeostasis. Here we review how iron therapy is changing because of such important advances in both pathophysiology and pharmacology.

show abstract

Section: The Chemistry Of Different IV Iron Preparations and Its Relamentioning

confidence: 99%

Modern iron replacement therapy: clinical and pathophysiological insights

et al. 2017

View full text Add to dashboard Cite

show abstract

“…41 Immediate side effects of intravenous iron infusion may be nausea, vomiting, headache, flushing, myalgia, pruritus, arthralgia, and back and chest pain. Hypophosphatemia is usually transient and asymptomatic.…”

Section: Intravenous Iron: Indications and Controversiesmentioning

confidence: 99%

“…Simple recommendations to minimize the risk include slow administration with careful patient monitoring during and after treatment, an adequate clinical environment with trained staff and the avoidance of antihistamine premedication. 41 Taking into account the ability of iron to generate oxidative stress and to increase susceptibility to infections 36 the long-term side effects of large amounts of iron administered when iron stores are not depleted (eg, in inflammation) remain to be verified.…”

Section: Intravenous Iron: Indications and Controversiesmentioning

confidence: 99%

Iron deficiency: new insights into diagnosis and treatment

2015

View full text Add to dashboard Cite

Iron deficiency and iron deficiency anemia are common conditions worldwide affecting especially children and young women. In developing countries, iron deficiency is caused by poor iron intake and/or parasitic infection, whereas vegetarian dietary choices, poor iron absorption, and chronic blood loss are common causes in high-income countries. Erythropoiesis stimulating agents can result in functional iron deficiency for erythropoiesis even when stores are iron-replete. Diagnosis of iron deficiency is straightforward, except when it occurs in the context of inflammatory disorders. Oral iron salts correct absolute iron deficiency in most patients, because low hepcidin levels facilitate iron absorption. Unfortunately frequent side effects limit oral iron efficacy. Intravenous iron is increasingly utilized, because currently available preparations allow rapid normalization of total body iron even with a single infusion and are effective also in functional iron deficiency and in iron deficiency associated with inflammatory disorders. The evidence is accumulating that these preparations are safe and effective. However, long-term safety issues of high doses of iron need to be further explored. Learning Objectives• To diagnose absolute iron deficiency, iron deficiency anemia, and functional iron deficiency in the light of recent advances in iron metabolism • To evaluate advantages and disadvantages of oral and intravenous iron therapy

show abstract

“…Current nomenclature relating to adverse reactions to intravenous drugs in general is confusing and inconsistent. As elsewhere, 15 we find it simplest to refer to all acute reactions to intravenous iron as hypersensitivity reactions (HSRs), subdividing them into mild, moderate or severe/life-threatening, depending on their clinical presentation (FIgure 1). As suggested by the World Allergy Organization, 38 we reserve the term "anaphylaxis" for severe HSRs, irrespective of pathogenesis, and avoid the ill-defined term "anaphylactoid".…”

Section: Monitoring Of Responsementioning

confidence: 99%

Treatment of iron deficiency anemia: practical considerations

Taylor¹,

Rampton²

2015

Polish Archives of Internal Medicine

View full text Add to dashboard Cite

The aims of this article, which is directed primarily at generalists, are to outline the relevant features of iron metabolism, to summarize the indications for treatment of IDA, and to compare the advantages and disadvantages of treatment with oral and intravenous iron. We shall then focus particularly on practical aspects of treatment with iron. Topics which we shall not cover include investigation of the cause of IDA (for guidance, see Goddard et al 3 ) and use of blood transfusion. We shall also omit the mention of therapy with erythropoietin, as this is a specialist treatment restricted primarily to patients with chronic kidney disease or having cancer chemotherapy.Iron metabolism As a background to our focus on the management of IDA, we provide below a brief overview of iron metabolism (for a comprehensive recent review, see Waldvogel-Abramowski et al 7 ).Iron absorption and turnover The human body contains from 30 to 40 mg/kg body weight of iron. It is mostly contained in hemoglobin (Hb), ferritin, and other heme and nonheme proteins. Iron is an essential element, being a constituent of a range of enzymes involved in redox reactions and oxygen delivery. Red blood cells have the highest demand for iron of all cells.Introduction Anemia is common in all populations worldwide and is frequently caused by iron deficiency. In developed countries, the prevalence of iron deficiency anemia (IDA) is from 2% to 5% in adult men and postmenopausal women and about 10% in women of child-bearing age; it is much more common in hospitalized patients. [1][2][3] Iron deficiency occurs when iron losses exceed its intestinal absorption. This happens in patients with decreased iron intake, malabsorption of iron, increased demand for iron, or through ongoing iron loss. In the Western world, while IDA is often multifactorial, menstruation is the most common single cause. Reduced dietary intake of iron (vegetarians and the elderly being particularly at risk), bleeding from the gastrointestinal tract (for example, due to neoplasia or use of aspirin or nonsteroidal anti-inflammatory drugs), malabsorption (particularly in celiac disease), pregnancy, and blood donation are other frequent causes. 3,4 IDA is associated with worsened quality of life, impaired physical and cognitive performance, 2,5 and in hospitalized patients, longer length of hospital stay and poorer clinical outcomes. 1,6 It also increases the likelihood of patients receiving blood transfusions with their attendant risks.1 Therefore, effective treatment of patients with IDA is extremely worthwhile. Key wordsanemia, intravenous iron, iron deficiency, hypersensitivity reactions, oral iron AbstrActIron deficiency anemia is a common problem worldwide, and doctors of all specialties need to be competent in its treatment. While most patients respond well to oral iron preparations, a substantial minority have side effects that make them adhere poorly to their treatment. For oral iron-intolerant patients, those responding poorly despite good adherence, and those with severe...

show abstract

Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management

Cited by 251 publications

References 29 publications

Modern iron replacement therapy: clinical and pathophysiological insights

Modern iron replacement therapy: clinical and pathophysiological insights

Iron deficiency: new insights into diagnosis and treatment

Treatment of iron deficiency anemia: practical considerations

Contact Info

Product

Resources

About