Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland.
Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland.
J Allergy Clin Immunol Pract. 2021 Jun;9(6):2406-2414.e2. doi: 10.1016/j.jaip.2021.01.009. Epub 2021 Jan 21.
Hypersensitivity reactions (HSRs) to nondextran iron products (NDIPs) are rare, but can manifest with severe signs and symptoms. Predisposing risk factors are not well understood.
To characterize patients with HSRs to NDIPs, with a special focus on possible risk factors.
We analyzed clinical characteristics of patients with HSRs to NDIPs referred to our allergy division between 2007 and 2019 compared with tolerant controls, including the type of the eliciting NDIP, severity and characteristics of the HSR, atopy status, history of allergies and urticaria, laboratory and skin test results, and outcome of reexposure with NDIPs.
We evaluated the data of 59 patients and 21 controls. Sixteen patients and 4 controls received the NDIP iron sucrose and 41 patients and 15 controls received ferric carboxymaltose. In 2 patients and in 2 controls, the culprit NDIP was not known. Twenty-seven patients (46%) experienced an anaphylactic reaction grade I, 15 (25%) a grade II reaction, and 17 (29%) a grade III reaction according to Ring and Messmer. On analyzing the history, we found that 22 patients (37%) and 3 controls (14%) reported previous HSRs to other medications. Interestingly, more than half the patients (n = 35 [59%]) compared with only 7 controls (33%) reported an episode of any type of urticaria in their previous history. Most patients (n = 15 [79%]) tolerated reexposure of an NDIP using a low-reactogenic administration protocol.
A history of drug hypersensitivity and urticaria represent potential risk factors for HSRs to NDIPs. On the basis of our findings, we propose an algorithm for practical management of patients receiving NDIPs aiming to prevent HSRs.
非右旋糖酐铁产品（NDIP）过敏反应（HSR）罕见，但可表现为严重的体征和症状。其易患风险因素尚未完全阐明。
对 NDIP 过敏反应患者的临床特征进行分析，重点探讨可能的风险因素。
回顾性分析了 2007 年至 2019 年期间因 NDIP 过敏反应而转诊至我院过敏科的患者与无过敏反应对照者的临床特征，包括引发 NDIP 的类型、HSR 的严重程度和特征、特应性状态、过敏和荨麻疹病史、实验室和皮肤试验结果以及再次接触 NDIP 时的结果。
共评估了 59 例患者和 21 例对照者的数据。16 例患者和 4 例对照者接受了 NDIP 蔗糖铁，41 例患者和 15 例对照者接受了羧基麦芽糖铁。2 例患者和 2 例对照者未知罪魁祸首 NDIP。27 例患者（46%）发生了 I 级过敏反应，15 例患者（25%）发生了 II 级反应，17 例患者（29%）发生了 III 级反应，根据 Ring 和 Messmer 分级标准。分析病史时发现，22 例患者（37%）和 3 例对照者（14%）报告了先前对其他药物的 HSR。有趣的是，与仅有 7 例对照者（33%）相比，超过一半的患者（n=35[59%]）报告了既往史中出现任何类型荨麻疹。大多数患者（n=15[79%]）采用低致敏性给药方案重新接受 NDIP 治疗后耐受良好。
药物过敏史和荨麻疹史是 NDIP 过敏反应的潜在危险因素。基于我们的发现，我们提出了一种针对接受 NDIP 治疗患者的实用管理算法，旨在预防 HSR。
