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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
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Approach to hypersensitivity reactions from intravenous iron preparations
C A Morales Mateluna1, K Scherer Hofmeier1, A J Bircher1
1Allergy Unit, Dermatology Clinic, University Hospital Basel, Basel, Switzerland.
Allergy
|December 16, 2016
Summary
Hypersensitivity reactions (HSRs) to intravenous iron preparations (IVIPs) are rare but can be severe. Controlled re-administration (CRA) of IVIPs under surveillance is safe for most patients, even those with prior severe reactions.
Area of Science:
- Immunology
- Pharmacology
Background:
- Hypersensitivity reactions (HSRs) to intravenous iron preparations (IVIPs) are a known clinical concern.
- While newer IVIP formulations have reduced HSR incidence, severe reactions can still occur, necessitating careful patient management.
Purpose of the Study:
- To evaluate the safety and outcomes of controlled re-administration (CRA) of IVIPs in patients previously experiencing HSRs.
- To determine the diagnostic utility of allergological work-up, including skin prick tests (SPTs) and basophil activation tests (BATs), in predicting HSRs to IVIPs.
Main Methods:
- Retrospective review of patient records for those evaluated for HSRs to IVIPs.
- Allergological work-up including detailed history, SPTs, and BATs (where applicable).
- Performance of CRA with IVIPs in selected patients under medical surveillance.
Main Results:
- Thirty-one patients with a history of mild to severe HSRs to IVIPs were assessed.
- SPTs and BATs yielded negative results in all tested patients.
- Of 15 patients who underwent CRA (18 procedures), 12 tolerated the re-administration, including three with prior severe (grade IV) HSRs. Two patients developed urticaria, and one experienced urticaria with dyspnea.
Conclusions:
- The pathophysiology of IVIP-induced HSRs remains poorly understood.
- Standard allergological tests (SPTs, BATs) did not provide additional diagnostic information in this cohort.
- Controlled re-administration of IVIPs under appropriate surveillance is a safe strategy for most patients with a history of HSRs.
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