Patients receiving intravenous iron replacement may have systemic hypersensitivity reactions during the infusion. We investigate the role of intravenous iron skin testing and the safety of intravenous iron desensitization with multiple formulations.
Patients with a history of iron hypersensitivity were evaluated in the Brigham and Women’s Hospital Allergy Clinic. Their records were reviewed and analyzed for skin testing results and the outcome of desensitization to intravenous iron.
12 patients with history of intravenous iron hypersensitivity were evaluated and desensitized between January 1, 2010 and July 31, 2015. Reactions ranged from itching to respiratory distress and hypotension. 8/12 patients reacted to more than one formulation. Skin testing was performed with sodium ferric gluconate, with 6/12 patients positive. 5 of those 6 patients reacted to more than one formulation. Patients were treated with sodium ferric gluconate, iron sucrose, iron dextran, or ferumoxytol in this cohort. All 12 patients were able to complete treatment with full doses of intravenous iron replacement using a 12-step or 16-step protocol. One of the 12 patients initially failed desensitization to iron dextran and iron sucrose before completing ferumoxytol by desensitization protocol.
Patients who reacted to more than one formulation of IV iron were more likely to have positive skin testing to sodium ferric gluconate. All the patients were able to receive at least one formulation of intravenous iron replacement safely. Intravenous iron replacement can be safely given using the 12-step and 16-step desensitization protocols.