Department of Immunology and Allergy, Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Int Arch Allergy Immunol. 2024;185(5):449-455. doi: 10.1159/000535785. Epub 2024 Jan 25.
Iron deficiency is the most common cause of anemia in both sexes, although it is more common in women. Intravenous (IV) iron replacement is preferred in patients who cannot tolerate oral treatment or when iron stores need to be replenished rapidly. In this study, we wanted to share the ferric carboxymaltose (FCM) desensitization protocol that we self-created and successfully applied.
This retrospective cross-sectional study included patients with a history of hypersensitivity reactions (HSRs) to IV or oral iron replacement and patients who were planned to receive IV iron replacement but were referred to the allergy clinic because of have risk factors (atopic diseases, history of HSR to other drugs, high serum tryptase levels, etc.) for HSRs. Before desensitization, some of the patients underwent skin tests (skin prick test and intradermal test) with FCM, and the results were recorded. Skin tests were not performed in patients with a history of drug use (antihistamine, systemic steroid, omalizumab, etc.) that affected the results of skin tests. All patients underwent a one-bag 8-step desensitization protocol with 500 mg FCM and were observed for 2 h after desensitization.
A total of 15 patients (14 females and 1 male) with a mean age of 41.13 ± 11.18 years were included in the study. When the patients were evaluated in terms of the risk of allergic reactions according to their clinical history, 8 patients had a history of anaphylaxis with iron preparations (FCM, n = 4; ferric hydroxide sucrose, n = 2; iron [II] glycine sulfate, n = 1; and iron [III] hydroxide polymaltose, n = 1), and 7 patients had a history of HSR other than anaphylaxis with iron preparations (urticaria, n = 6 [FCM, n = 2; iron (II) glycine sulfate, n = 2; and iron (III) hydroxide polymaltose, n = 2] and urticaria + angioedema [ferric hydroxide sucrose, n = 1]). Desensitization was successfully completed in all patients. No HSR was observed during or after the procedure in any of the patients.
IV iron replacement is a very effective method, especially in cases where iron stores need to be replenished more rapidly. In patients with a history of iron HSR or at risk of developing HSR, replacement can be safely performed without an allergic reaction with successful desensitization protocols.
缺铁是两性贫血最常见的原因，尽管女性更为常见。不能耐受口服治疗或需要快速补充铁储存的患者，首选静脉（IV）铁替代治疗。在这项研究中，我们想要分享我们自创的并成功应用的三价羧基麦芽糖铁（FCM）脱敏方案。
这是一项回顾性的横断面研究，包括对静脉或口服铁替代治疗有过敏反应（HSR）史的患者，以及因存在 HSR 危险因素（特应性疾病、对其他药物的 HSR 史、血清胰蛋白酶水平升高等）而计划接受 IV 铁替代治疗但转至过敏科的患者。在脱敏前，对部分患者进行了 FCM 的皮肤测试（皮肤点刺试验和皮内试验），并记录了结果。在有影响皮肤试验结果的药物使用史（抗组胺药、全身皮质类固醇、奥马珠单抗等）的患者中，不进行皮肤试验。所有患者均采用 1 袋 8 步 FCM 脱敏方案，在脱敏后 2 小时进行观察。
共纳入 15 名患者（14 名女性和 1 名男性），平均年龄为 41.13±11.18 岁。根据临床病史评估患者发生过敏反应的风险时，8 名患者有铁制剂过敏史（FCM 4 名，Ferric Hydroxide Sucrose 2 名，Iron [II] Glycine Sulfate 1 名，Iron [III] Hydroxide Polymaltose 1 名），7 名患者有铁制剂以外的 HSR 史（荨麻疹，6 名患者[FCM 2 名，Iron [II] Glycine Sulfate 2 名，Iron [III] Hydroxide Polymaltose 2 名]和荨麻疹+血管性水肿[Ferric Hydroxide Sucrose 1 名]）。所有患者均成功完成脱敏。在任何患者中，在程序期间或之后均未观察到 HSR。
静脉铁替代治疗是一种非常有效的方法，特别是在需要更快补充铁储存的情况下。在有铁 HSR 史或有发生 HSR 风险的患者中，使用成功的脱敏方案可以安全地进行替代治疗，而不会发生过敏反应。
