Can iron infusions cause a delayed burning sensation to the feet and hands?

Iron Infusions and Delayed Burning Sensations in Extremities

Yes, iron infusions can cause delayed burning sensations in the feet and hands, which are documented as part of delayed hypersensitivity reactions to intravenous iron preparations. 1

Types of Reactions to IV Iron

• Intravenous iron can cause both immediate and delayed adverse reactions, with delayed reactions characterized by symptoms including arthralgias, myalgias, and potentially burning sensations in extremities 1
• These delayed reactions are distinct from the more severe immediate hypersensitivity reactions that can occur during infusion 1
• The mechanism is likely related to complement activation-related pseudo-allergy (CARPA) triggered by iron nanoparticles rather than true IgE-mediated allergic reactions 1, 2

Specific Delayed Reactions by Iron Formulation

Iron Dextran

• Delayed reactions to IV iron dextran, characterized by arthralgias and myalgias (which can manifest as burning sensations), are dose-related and occur in up to 59% of patients receiving total dose infusions 1, 3
• These reactions typically occur hours to days after infusion and can be managed with NSAIDs 1, 3

Iron Gluconate and Iron Sucrose

• Although less common than with iron dextran, delayed reactions including paresthesias (which can include burning sensations) have been reported with iron gluconate and iron sucrose 1, 4
• A case report documents severe leg pain, muscular stiffness, and functional impairment of extremities following ferric gluconate infusion, suggesting peripheral nervous system involvement 4
• Paresthesias and flushing have been specifically reported with iron gluconate infusions 5

Risk Factors for Delayed Reactions

• Higher doses of iron (particularly with total dose infusions) significantly increase the risk of delayed reactions 1
• Faster infusion rates are associated with higher risk of both immediate and delayed reactions 1, 6
• Patients with inflammatory conditions appear to be at higher risk for experiencing these delayed symptoms 2, 4
• Previous reactions to iron infusions increase the likelihood of subsequent reactions 1, 7

Management of Delayed Burning Sensations

• NSAIDs are the first-line treatment for delayed reactions including burning sensations in extremities 1, 7
• For more severe symptoms, corticosteroids may be considered 1, 7
• Slowing the infusion rate in subsequent treatments can reduce the risk of recurrence 5
• If symptoms persist or are severe, consider switching to a different iron formulation 7, 6

Prevention Strategies

• Use slower infusion rates, especially for patients with previous reactions 1, 7
• Consider lower individual doses given more frequently rather than large single doses 1, 6
• Monitor patients for at least 15 minutes after infusion and educate them about potential delayed reactions 1
• Ensure patients understand to report delayed symptoms like burning sensations in extremities, as these may indicate a reaction requiring medical attention 1, 7

Important Considerations

• The burning sensation in hands and feet could potentially represent a form of peripheral neuropathy related to oxidative stress from free iron 4
• These symptoms should be distinguished from more serious conditions like rhabdomyolysis, which has been reported following iron infusions 4
• While most delayed reactions are self-limiting, persistent or severe burning sensations warrant medical evaluation 1, 7