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.
authors.affiliation: Barts and the London School of Medicine and Dentistry, London, UK d.rampton@qmul.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Rampton
authors.affiliation: Medbusiness, Farum, Denmark.
authors.forename: Joergen
authors.initials: J
authors.lastname: Folkersen
authors.affiliation: Hofstra North Shore-LIJ School of Medicine, New York, NY, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Fishbane
authors.affiliation: Dept of Haematology, Sundsvalls Hospital, Sundsvall, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Hedenus
authors.affiliation: Research Institute for IBD, HaFCED GmbH&Co. KG, Hamburg, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Howaldt
authors.affiliation: Alessandro Manzoni Hospital, Lecco, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.affiliation: Birmingham Heartlands Hospital, UK.
authors.forename: Shalini
authors.initials: S
authors.lastname: Patni
authors.affiliation: Nanomedicine Research and Education Center, Semmelweis University, Budapest, Hungary.
authors.forename: Janos
authors.initials: J
authors.lastname: Szebeni
authors.affiliation: Department for Internal Medicine VI, Medical University of Innsbruck, Austria.
authors.forename: Guenter
authors.initials: G
authors.lastname: Weiss
mesh_terms: D061605:Administration, Intravenous; D018798:Anemia, Iron-Deficiency / Q000150:complications* / Q000188:drug therapy; D019468:Disease Management; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D007501:Iron