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, Janos Szebeni, Guenter Weiss

Research output: Article

115 Citations (Scopus)


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
Issue number11
Publication statusPublished - nov. 1 2014


ASJC Scopus subject areas

  • Hematology

Cite this

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, 99(11), 1671-1676. https://doi.org/10.3324/haematol.2014.111492