Canadian expert consensus: management of hypersensitivity reactions to intravenous iron in adults

Wendy Lim; Waqqas Afif; Sandra Knowles; Gloria Lim; Yulia Lin; Charmaine Mothersill; Irina Nistor; Faisal Rehman; Christine Song; Ted Xenodemetropoulos

doi:10.1111/vox.12773

Canadian expert consensus: management of hypersensitivity reactions to intravenous iron in adults

Vox Sang. 2019 May;114(4):363-373. doi: 10.1111/vox.12773. Epub 2019 Apr 2.

Authors

Wendy Lim¹, Waqqas Afif², Sandra Knowles³, Gloria Lim⁴, Yulia Lin⁵, Charmaine Mothersill⁴, Irina Nistor^{6

7}, Faisal Rehman⁸, Christine Song⁹, Ted Xenodemetropoulos¹⁰

Affiliations

¹ Department of Medicine, Division of Hematology and Thromboembolism, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada.
² Department of Medicine, Division of Gastroenterology and Hepatology, Montreal General Hospital, McGill University, Montreal, QC, Canada.
³ Department of Pharmacy, Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁴ Department of Medicine, Division of Hematology and Oncology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
⁵ Department of Laboratory Medicine and Molecular Diagnostics, Division of Clinical Pathology, Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
⁶ Department of Gastroenterology and Hepatology, Halton Healthcare Services, Oakville, ON, Canada.
⁷ Queen's University, Kingston, ON, Canada.
⁸ Department of Medicine, Division of Nephrology, University Hospital, London Health Sciences Centre, Western University, London, ON, Canada.
⁹ Department of Medicine, Division of Allergy and Immunology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Medicine, Division of Gastroenterology, McMaster University Medical Centre, McMaster University, Hamilton, ON, Canada.

Abstract

Background and objectives: Rare but potentially life-threatening hypersensitivity reactions can occur during the administration of intravenous iron. To provide guidance to healthcare professionals caring for adults receiving intravenous iron, a panel of 10 Canadian clinical experts developed a practical algorithm for the identification and management of hypersensitivity reactions to intravenous iron.

Materials and methods: A systematic search of PubMed to February 2018 was performed. Articles related to hypersensitivity reactions were selected for review. The algorithm was developed during a 1-day live meeting based on the literature review and clinical expertise where evidence was lacking. The algorithm was then refined through an iterative process involving a web-based platform and virtual meetings.

Results: The algorithm provides guidance to healthcare professionals in preparing for and administering IV iron, as well as recognizing and managing hypersensitivity reactions to intravenous iron. Considerations for re-challenging patients who have experienced prior reactions are provided.

Conclusion: Healthcare professionals who are involved in the care of patients receiving intravenous iron should be trained to anticipate, recognize and manage hypersensitivity reactions to intravenous iron to optimize patient care.

Keywords: anaphylaxis; consensus; hypersensitivity reactions; intravenous iron.

Publication types

Review

MeSH terms

Adult
Algorithms
Anaphylaxis
Canada
Consensus
Female
Hematology / standards*
Humans
Hypersensitivity
Infusions, Intravenous / adverse effects*
Internet
Iron / administration & dosage
Iron / adverse effects*
Male
Patient Safety
Quality of Health Care
Societies, Medical

Substances

ferryl iron
Iron

Grants and funding

Pfizer Canada