Novey H S, Pahl M, Haydik I, Vaziri N D
Department of Medicine, University of California, Irvine.
Ann Allergy. 1994 Mar;72(3):224-8.
Systemic reactions resembling anaphylaxis have occurred after intravenous (IV) iron-dextran administration, a treatment modality that has acquired increased acceptance following the use of erythropoietin for the anemia of patients with chronic renal diseases. Three such patients sustained anaphylactoid reactions immediately after receiving IV test doses of iron-dextran which were their only known exposures. In an effort to determine the mechanism of their reactions, we applied tests for (1) basophil degranulation by iron-dextran, basophil histamine release; (2) a type I anaphylactic reaction, specific IgE antibodies; and (3) an immune complex activation, specific IgG antibodies against iron-dextran. Six other patients with renal diseases served as controls, three of whom had tolerated IV iron-dextran, and three without known exposure. One patient only had any test abnormalities. Her initial positive basophil histamine release and specific IgG antibodies reversed and declined respectively at a 4-month follow-up study. She had developed anaphylaxis, and her studies had been performed at a time after anaphylaxis earlier than the other two. The mechanisms of iron-dextran anaphylaxis may be multiple and not be detectable several months after the incident. Prospective studies will probably be required for a predictive test to be developed.
静脉注射右旋糖酐铁后出现了类似过敏反应的全身反应，在使用促红细胞生成素治疗慢性肾病患者贫血后，这种治疗方式越来越被接受。三名此类患者在接受静脉注射右旋糖酐铁试验剂量后立即出现类过敏反应，这是他们唯一已知的接触情况。为了确定其反应机制，我们进行了以下检测：（1）右旋糖酐铁诱导的嗜碱性粒细胞脱颗粒、嗜碱性粒细胞组胺释放；（2）I型过敏反应，特异性IgE抗体；（3）免疫复合物激活，抗右旋糖酐铁特异性IgG抗体。另外六名肾病患者作为对照，其中三名耐受静脉注射右旋糖酐铁，三名无已知接触史。只有一名患者的检测出现异常。在4个月的随访研究中，她最初阳性的嗜碱性粒细胞组胺释放和特异性IgG抗体分别逆转和下降。她曾发生过敏反应，且她的检测是在过敏反应发生后的一个时间点进行的，比其他两人更早。右旋糖酐铁过敏反应的机制可能是多方面的，且在事件发生数月后可能无法检测到。可能需要进行前瞻性研究来开发预测性检测。
