High-dose intravenous desferrioxamine (DFO) delivery in four thalassemic patients allergic to subcutaneous DFO administration.
To test the hypothesis that allergy to desferrioxamine is not an immunologic mechanism, but arises from a local effect on the dermal mast cell, we have treated four patients who were not receiving chelation therapy because of hypersensitivity to standard subcutaneous (SC) therapy, with high-dose desferrioxamine (DFO) by the intravenous (IV) route. Three patients had central venous access ports implanted on the anterior chest wall. The fourth patient had the therapy delivered by the peripheral vein route. All patients had the drug delivered via an elastomeric infusor. Intravenous therapy was successful for all patients. During one year of therapy no local or systemic allergic manifestations were noted. In addition, no impairment of hearing or vision or any catheter complications were reported. A very high level of patient compliance to the therapy resulted in dramatically decreased iron stores and ferritin levels (2,759 ng/ml to 717.5 ng/ml) and a significant improvement in the clinical status of all patients. The absence of allergic episodes in this patient group after 1 year of i.v. therapy would strongly support the hypothesis that SC DFO allergy is related to a direct effect on dermal mast cells and is not an immunological reaction. This study suggests that patients with severe allergy to SC DFO can therefore safely receive their chelation therapy via the i.v. route.
Lombardo
T
T
Servizio Talassemia, Ospedale Ferrarotto USL 35 Catania, Italy.
Ferro
G
G
Frontini
V
V
Percolla
S
S
D000293:Adolescent; D000328:Adult; D002408:Catheters, Indwelling; D015913:Chelation Therapy / Q000009:adverse effects; D003676:Deferoxamine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005293:Ferritins / Q000032:analysis; D006432:Hemochromatosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007501:Iron; D008297:Male; D017262:Siderophores / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D065227:Transfusion Reaction; D017086:beta-Thalassemia / Q000150:complications*
D017262:Siderophores; D005293:Ferritins; D007501:Iron; D003676:Deferoxamine