From the Guidelines
The Fishbane reaction, also known as complement activated related pseudo-allergy (CARPA), is a common infusion reaction associated with intravenous iron administration, which is physiologically different from an anaphylactic reaction. This reaction is characterized by its occurrence during or after the infusion of intravenous iron, and it is thought to be caused by the activation of the complement system 1. The symptoms of the Fishbane reaction can vary, but they often include flushing, rash, and hypotension.
Key Characteristics of the Fishbane Reaction
- It is a common infusion reaction associated with intravenous iron administration 1
- It is physiologically different from an anaphylactic reaction 1
- It is thought to be caused by the activation of the complement system 1
- Symptoms can include flushing, rash, and hypotension
Management and Prevention
The management of the Fishbane reaction typically involves stopping the infusion and administering supportive care, such as antihistamines and corticosteroids 1. In some cases, the infusion can be restarted at a slower rate, but this should be done with caution and under close monitoring. Prevention of the Fishbane reaction is also important, and this can be achieved by using newer iron formulations that are less likely to cause infusion reactions 1. Additionally, pre-medication with antihistamines and corticosteroids can also be used to reduce the risk of the Fishbane reaction 1.
From the Research
Definition of Fishbane Reaction
- The Fishbane reaction is a type of infusion reaction characterized by transient flushing and truncal myalgias 2.
- It is a specific type of reaction that occurs in response to intravenous iron infusion.
Characteristics of Fishbane Reaction
- The reaction is typically mild and self-limiting, with symptoms resolving on their own or with minimal treatment 2.
- It is distinct from other types of infusion reactions, such as hypersensitivity reactions or delayed reactions.
Management of Fishbane Reaction
- Recommencement of the index infusion is safe for Fishbane reactions, and can be done with a reduced infusion rate and premedication 2.
- Subsequent rechallenge to an alternative formulation of intravenous iron is also tolerated, including in cases of severe hypersensitivity reactions 2.
Comparison to Other Reactions
- The Fishbane reaction is different from anaphylaxis, which is a severe, life-threatening allergic reaction that requires immediate treatment with epinephrine 3, 4.
- It is also distinct from other types of adverse drug reactions, such as drug allergy or intolerance, which may have different mechanisms and clinical presentations 5, 6.