From the Guidelines
If you experience a reaction to intravenous (IV) iron, stop the infusion immediately and notify healthcare staff. According to the expert consensus guidelines 1, the first step in managing an IV iron reaction is to stop the infusion and assess the patient's symptoms. Mild reactions like headache, flushing, or joint pain may resolve with slowing the infusion rate, but more severe reactions require prompt medical attention. The guidelines recommend performing a physical assessment of the patient's symptoms, seeking medical attention if symptoms do not resolve, and continuing close monitoring of vital signs and symptoms until the patient is stable 1.
For severe reactions, treatment may include corticosteroids, such as methylprednisolone, and oxygen supplementation 1. It's essential to note that true anaphylaxis is very rare, and most reactions to intravenous iron are complement activation–related pseudo-allergy (infusion reactions) 1. After any reaction, the doctor should document the event, consider switching to a different iron formulation for future treatments, and may recommend premedication with antihistamines and/or corticosteroids before subsequent infusions.
Some key points to consider when managing IV iron reactions include:
- Stopping the infusion immediately and notifying healthcare staff
- Assessing the patient's symptoms and performing a physical assessment
- Seeking medical attention if symptoms do not resolve
- Continuing close monitoring of vital signs and symptoms until the patient is stable
- Considering treatment with corticosteroids and oxygen supplementation for severe reactions
- Documenting the event and considering switching to a different iron formulation for future treatments 1, 1, 1.
From the Research
IV Iron Reaction Management
In the event of an IV iron reaction, the following steps can be taken:
- Immediate cessation of the infusion is the first intervention 2, 3
- Evaluation of the severity of the reaction and treatment should follow 2
- Aggressively treating infusion reactions with H1-antihistamines or vasopressors should be avoided 2, 4
- Recommencement of the index infusion or subsequent rechallenge can be considered in some cases, depending on the type and severity of the reaction 3
Prevention of Infusion Reactions
To prevent infusion reactions, the following measures can be taken:
- Informing patients about infusion reactions and identifying those with increased risk of hypersensitivity or contraindications for intravenous iron 2
- Starting the infusion at a low rate for a few minutes 2
- Using alternative formulations, such as ferric carboxymaltose, which have been shown to have a lower rate of infusion reactions 4, 5
Treatment of Infusion Reactions
The treatment of infusion reactions depends on the severity of the reaction:
- Mild reactions may not require treatment, while more severe reactions may require medical attention 4, 3
- The use of premedication, such as diphenhydramine and acetaminophen, may reduce the risk of adverse events, but its use is not universally recommended 5, 6
- The administration of epinephrine may be necessary in severe cases, but this is rare 5