Hypersensitivity to Intravenous Iron Preparations

doi:10.3390/children9101473

Review

. 2022 Sep 27;9(10):1473.

doi: 10.3390/children9101473.

Hypersensitivity to Intravenous Iron Preparations

Affiliations

¹ UOC Pediatria, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
² UOC Pediatria, Università di Messina, 98124 Messina, Italy.
³ UOC Pediatria, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", 60020 Ancona, Italy.
⁴ UOC Pediatria, Azienda Ospedaliera San Camillo Forlanini, 00152 Roma, Italy.
⁵ Dipartimento di Pediatria e Neonatologia, Ospedale di Imola, 40026 Imola, Italy.
⁶ Allergy Unit, Meyer Children's Hospital, 50139 Florence, Italy.
⁷ UOC di Pediatria, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, 70123 Bari, Italy.
⁸ SC Pediatria, Ospedale Latisana-Palmanova, Dipartimento Materno-Infantile Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy.
⁹ Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
¹⁰ Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy.
¹¹ Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Dipartimento Medicina e Chirurgia, Università di Parma, 43126 Parma, Italy.

PMID: 36291409
PMCID: PMC9600424
DOI: 10.3390/children9101473

Review

Hypersensitivity to Intravenous Iron Preparations

Silvia Caimmi et al. Children (Basel). 2022.

. 2022 Sep 27;9(10):1473.

doi: 10.3390/children9101473.

Affiliations

¹ UOC Pediatria, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
² UOC Pediatria, Università di Messina, 98124 Messina, Italy.
³ UOC Pediatria, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", 60020 Ancona, Italy.
⁴ UOC Pediatria, Azienda Ospedaliera San Camillo Forlanini, 00152 Roma, Italy.
⁵ Dipartimento di Pediatria e Neonatologia, Ospedale di Imola, 40026 Imola, Italy.
⁶ Allergy Unit, Meyer Children's Hospital, 50139 Florence, Italy.
⁷ UOC di Pediatria, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, 70123 Bari, Italy.
⁸ SC Pediatria, Ospedale Latisana-Palmanova, Dipartimento Materno-Infantile Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy.
⁹ Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
¹⁰ Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy.
¹¹ Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Dipartimento Medicina e Chirurgia, Università di Parma, 43126 Parma, Italy.

PMID: 36291409
PMCID: PMC9600424
DOI: 10.3390/children9101473

Abstract

Intravenous iron is widely used for the treatment of iron deficiency anemia when adherence to oral iron replacement is poor. Acute hypersensitivity reactions during iron infusions are very rare but can be life threatening. Major risk factors for hypersensitivity reactions include a previous reaction to an iron infusion, a fast iron infusion rate, multiple drug allergies, atopic diseases, high serum tryptase levels, asthma, and urticaria. The management of iron infusions requires meticulous observation, and, in the event of an adverse reaction, prompt recognition and severity-related interventions by well-trained medical and nursing staff. Avoidance of IV iron products in patients with iron hypersensitivity reactions may not be considered as a standard practice.

Keywords: desensitization; drug allergy; drug provocation test; hypersensitivity reaction; iron; iron hypersensitivity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Iron–carbohydrate particles.

See this image and copyright information in PMC

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References

1. Auerbach M., Gafter Gvili A., Mac Dougall I.C. Intravenous iron: A framework for changing the management of iron deficiency. Lancet Hematol. 2020;7:e342–e350. doi: 10.1016/S2352-3026(19)30264-9. - DOI - PubMed
1. Funk F., Fluhmann B., Barton A.E. Criticality of Surface Characteristics of Intravenous Iron–Carbohydrate Nanoparticle Complexes: Implications for Pharmacokinetics and Pharmacodynamics. Int. J. Mol. Sci. 2022;23:2140. doi: 10.3390/ijms23042140. - DOI - PMC - PubMed
1. Gómez-Ramírez S., Shander A., Spahn D.R., Auerbach M., Liumbruno G.M., Vaglio S., Muñoz M. Management of acute intravenous iron reactions. Blood Transfus. 2019;17:137–145. - PMC - PubMed
1. Chertow G.M., Mason P.D., Vaage-Nilsen O., Ahlmen J. Update on adverse drug events associated with parenteral iron. Nephrol. Dial. Transplant. 2006;21:378–382. doi: 10.1093/ndt/gfi253. - DOI - PubMed
1. Fortuny J., von Gersdorff G., Lassalle R., Linder M., Overbeek J., Reinold J., Toft G., Timmer A., Dress J., Blin P., et al. Use of intravenous iron and risk of anaphylaxis: A multinational observational post-authorisation safety study in Europe. Pharmacoepidemiol. Drug Saf. 2021;30:1447–1457. doi: 10.1002/pds.5319. - DOI - PMC - PubMed

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[1] Auerbach M., Gafter Gvili A., Mac Dougall I.C. Intravenous iron: A framework for changing the management of iron deficiency. Lancet Hematol. 2020;7:e342–e350. doi: 10.1016/S2352-3026(19)30264-9. - DOI - PubMed

[2] Auerbach M., Gafter Gvili A., Mac Dougall I.C. Intravenous iron: A framework for changing the management of iron deficiency. Lancet Hematol. 2020;7:e342–e350. doi: 10.1016/S2352-3026(19)30264-9. - DOI - PubMed

[3] Funk F., Fluhmann B., Barton A.E. Criticality of Surface Characteristics of Intravenous Iron–Carbohydrate Nanoparticle Complexes: Implications for Pharmacokinetics and Pharmacodynamics. Int. J. Mol. Sci. 2022;23:2140. doi: 10.3390/ijms23042140. - DOI - PMC - PubMed

[4] Funk F., Fluhmann B., Barton A.E. Criticality of Surface Characteristics of Intravenous Iron–Carbohydrate Nanoparticle Complexes: Implications for Pharmacokinetics and Pharmacodynamics. Int. J. Mol. Sci. 2022;23:2140. doi: 10.3390/ijms23042140. - DOI - PMC - PubMed

[5] Gómez-Ramírez S., Shander A., Spahn D.R., Auerbach M., Liumbruno G.M., Vaglio S., Muñoz M. Management of acute intravenous iron reactions. Blood Transfus. 2019;17:137–145. - PMC - PubMed

[6] Gómez-Ramírez S., Shander A., Spahn D.R., Auerbach M., Liumbruno G.M., Vaglio S., Muñoz M. Management of acute intravenous iron reactions. Blood Transfus. 2019;17:137–145. - PMC - PubMed

[7] Chertow G.M., Mason P.D., Vaage-Nilsen O., Ahlmen J. Update on adverse drug events associated with parenteral iron. Nephrol. Dial. Transplant. 2006;21:378–382. doi: 10.1093/ndt/gfi253. - DOI - PubMed

[8] Chertow G.M., Mason P.D., Vaage-Nilsen O., Ahlmen J. Update on adverse drug events associated with parenteral iron. Nephrol. Dial. Transplant. 2006;21:378–382. doi: 10.1093/ndt/gfi253. - DOI - PubMed

[9] Fortuny J., von Gersdorff G., Lassalle R., Linder M., Overbeek J., Reinold J., Toft G., Timmer A., Dress J., Blin P., et al. Use of intravenous iron and risk of anaphylaxis: A multinational observational post-authorisation safety study in Europe. Pharmacoepidemiol. Drug Saf. 2021;30:1447–1457. doi: 10.1002/pds.5319. - DOI - PMC - PubMed

[10] Fortuny J., von Gersdorff G., Lassalle R., Linder M., Overbeek J., Reinold J., Toft G., Timmer A., Dress J., Blin P., et al. Use of intravenous iron and risk of anaphylaxis: A multinational observational post-authorisation safety study in Europe. Pharmacoepidemiol. Drug Saf. 2021;30:1447–1457. doi: 10.1002/pds.5319. - DOI - PMC - PubMed

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Hypersensitivity to Intravenous Iron Preparations

Affiliations

Hypersensitivity to Intravenous Iron Preparations

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