Intravenous iron reactions: Insights from an allergy and immunology perspective
Background: Diagnosis and management of intravenous iron reactions is often challenging, as skin testing has unproven utility and most reactions are non–IgE-mediated. Objective: We aimed to identify clinical patterns and tolerability predictors in patients with reactions to intravenous iron. Methods...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-11-01
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| Series: | Journal of Allergy and Clinical Immunology: Global |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772829325001444 |
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| Summary: | Background: Diagnosis and management of intravenous iron reactions is often challenging, as skin testing has unproven utility and most reactions are non–IgE-mediated. Objective: We aimed to identify clinical patterns and tolerability predictors in patients with reactions to intravenous iron. Methods: We conducted a retrospective cohort study of patients with reactions to intravenous iron who were referred to the Vanderbilt University Medical Center Drug Allergy Clinic from April 2014 through January 2025 and administered a follow-up survey via RedCap to evaluate patient outcomes with future intravenous iron administration. Results: Of the 51 patients presenting for adverse reactions to intravenous iron, 48 had skin testing performed. The skin testing results were deemed negative in all 48 cases (100%). Notable laboratory test results within 1 year of reaction were low vitamin D level (47%), high parathyroid hormone level (46%), and low phosphorus level (10%). Many patients (56%) were dermatographic, and their drug alert labels included opioids (31%), fluoroquinolones (14%), and radiocontrast dye (8%). Following assessment, 31 patients received intravenous iron (61%) using formulations that were the same as (n = 15 [48%]) and/or different from (n = 17 [55%]) the forumlation initially implicated, with the various modifications including antihistamines, slower infusion rate, and intravenous fluid pretreatment. Of these 31 patients, 27 (87%) tolerated the infusions. Additionally, following evaluation, the patients were surveyed regarding subsequent intravenous iron administrations, eliciting a 29% response rate (n = 15). Of the responders, 7 patients (47%) reported receiving intravenous iron after evaluation; all 7 reported tolerance. Conclusion: Most reactions to intravenous iron are non–IgE-mediated; however, our study introduces 2 novel observations, namely, a high frequency of dermatographism (56%) and common colabeling of these patients with drug alerts to Mas-related G protein–coupled receptor X2 (MRGPRX2)-activating drugs, suggesting a possible shared pathophysiologic mechanism. |
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| ISSN: | 2772-8293 |