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

David Rampton, Joergen Folkersen, Steven Fishbane, Michael Hedenus, Stefanie Howaldt, Francesco Locatelli, Shalini Patni, J. Szebeni, Guenter Weiss

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Intravenous iron is widely used for the treatment of iron deficiency anemia when oral iron is inappropriate, ineffective or poorly tolerated. Acute hypersensitivity reactions during iron infusions are very rare but can be life-threatening. This paper reviews their frequency, pathogenesis and risk factors, and provides recommendations about their management and prevention. Complement activation-related pseudo-allergy triggered by iron nanoparticles is probably a more frequent pathogenetic mechanism in acute reactions to current formulations of intravenous iron than is an immunological IgE-mediated response. Major risk factors for hypersensitivity reactions include a previous reaction to an iron infusion, a fast iron infusion rate, multiple drug allergies, severe atopy, and possibly systemic inflammatory diseases. Early pregnancy is a contraindication to iron infusions, while old age and serious co-morbidity may worsen the impact of acute reactions if they occur. 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.

Original languageEnglish
Pages (from-to)1671-1676
Number of pages6
JournalHaematologica
Volume99
Issue number11
DOIs
Publication statusPublished - Nov 1 2014

Fingerprint

Risk Management
Hypersensitivity
Iron
Drug Hypersensitivity
Iron-Deficiency Anemias
Complement Activation
Nursing Staff
Medical Staff
Nanoparticles
Immunoglobulin E
Observation
Morbidity
Pregnancy

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

Cite this

Rampton, D., Folkersen, J., Fishbane, S., Hedenus, M., Howaldt, S., Locatelli, F., ... Weiss, G. (2014). Hypersensitivity reactions to intravenous iron: Guidance for risk minimization and management. Haematologica, 99(11), 1671-1676. https://doi.org/10.3324/haematol.2014.111492

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, J.; Weiss, Guenter.

In: Haematologica, Vol. 99, No. 11, 01.11.2014, p. 1671-1676.

Research output: Contribution to journalArticle

Rampton, D, Folkersen, J, Fishbane, S, Hedenus, M, Howaldt, S, Locatelli, F, Patni, S, Szebeni, J & Weiss, G 2014, 'Hypersensitivity reactions to intravenous iron: Guidance for risk minimization and management', Haematologica, vol. 99, no. 11, pp. 1671-1676. https://doi.org/10.3324/haematol.2014.111492
Rampton D, Folkersen J, Fishbane S, Hedenus M, Howaldt S, Locatelli F et al. Hypersensitivity reactions to intravenous iron: Guidance for risk minimization and management. Haematologica. 2014 Nov 1;99(11):1671-1676. https://doi.org/10.3324/haematol.2014.111492
Rampton, David ; Folkersen, Joergen ; Fishbane, Steven ; Hedenus, Michael ; Howaldt, Stefanie ; Locatelli, Francesco ; Patni, Shalini ; Szebeni, J. ; Weiss, Guenter. / Hypersensitivity reactions to intravenous iron : Guidance for risk minimization and management. In: Haematologica. 2014 ; Vol. 99, No. 11. pp. 1671-1676.
@article{066ea6ff96f1473c896a92c2cfb56250,
title = "Hypersensitivity reactions to intravenous iron: Guidance for risk minimization and management",
abstract = "Intravenous iron is widely used for the treatment of iron deficiency anemia when oral iron is inappropriate, ineffective or poorly tolerated. Acute hypersensitivity reactions during iron infusions are very rare but can be life-threatening. This paper reviews their frequency, pathogenesis and risk factors, and provides recommendations about their management and prevention. Complement activation-related pseudo-allergy triggered by iron nanoparticles is probably a more frequent pathogenetic mechanism in acute reactions to current formulations of intravenous iron than is an immunological IgE-mediated response. Major risk factors for hypersensitivity reactions include a previous reaction to an iron infusion, a fast iron infusion rate, multiple drug allergies, severe atopy, and possibly systemic inflammatory diseases. Early pregnancy is a contraindication to iron infusions, while old age and serious co-morbidity may worsen the impact of acute reactions if they occur. 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.",
author = "David Rampton and Joergen Folkersen and Steven Fishbane and Michael Hedenus and Stefanie Howaldt and Francesco Locatelli and Shalini Patni and J. Szebeni and Guenter Weiss",
year = "2014",
month = "11",
day = "1",
doi = "10.3324/haematol.2014.111492",
language = "English",
volume = "99",
pages = "1671--1676",
journal = "Haematologica",
issn = "0390-6078",
publisher = "Ferrata Storti Foundation",
number = "11",

}

TY - JOUR

T1 - Hypersensitivity reactions to intravenous iron

T2 - Guidance for risk minimization and management

AU - Rampton, David

AU - Folkersen, Joergen

AU - Fishbane, Steven

AU - Hedenus, Michael

AU - Howaldt, Stefanie

AU - Locatelli, Francesco

AU - Patni, Shalini

AU - Szebeni, J.

AU - Weiss, Guenter

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Intravenous iron is widely used for the treatment of iron deficiency anemia when oral iron is inappropriate, ineffective or poorly tolerated. Acute hypersensitivity reactions during iron infusions are very rare but can be life-threatening. This paper reviews their frequency, pathogenesis and risk factors, and provides recommendations about their management and prevention. Complement activation-related pseudo-allergy triggered by iron nanoparticles is probably a more frequent pathogenetic mechanism in acute reactions to current formulations of intravenous iron than is an immunological IgE-mediated response. Major risk factors for hypersensitivity reactions include a previous reaction to an iron infusion, a fast iron infusion rate, multiple drug allergies, severe atopy, and possibly systemic inflammatory diseases. Early pregnancy is a contraindication to iron infusions, while old age and serious co-morbidity may worsen the impact of acute reactions if they occur. 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.

AB - Intravenous iron is widely used for the treatment of iron deficiency anemia when oral iron is inappropriate, ineffective or poorly tolerated. Acute hypersensitivity reactions during iron infusions are very rare but can be life-threatening. This paper reviews their frequency, pathogenesis and risk factors, and provides recommendations about their management and prevention. Complement activation-related pseudo-allergy triggered by iron nanoparticles is probably a more frequent pathogenetic mechanism in acute reactions to current formulations of intravenous iron than is an immunological IgE-mediated response. Major risk factors for hypersensitivity reactions include a previous reaction to an iron infusion, a fast iron infusion rate, multiple drug allergies, severe atopy, and possibly systemic inflammatory diseases. Early pregnancy is a contraindication to iron infusions, while old age and serious co-morbidity may worsen the impact of acute reactions if they occur. 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.

UR - http://www.scopus.com/inward/record.url?scp=84908459097&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908459097&partnerID=8YFLogxK

U2 - 10.3324/haematol.2014.111492

DO - 10.3324/haematol.2014.111492

M3 - Article

C2 - 25420283

AN - SCOPUS:84908459097

VL - 99

SP - 1671

EP - 1676

JO - Haematologica

JF - Haematologica

SN - 0390-6078

IS - 11

ER -