From the Guidelines
For patients allergic to iron, intravenous iron supplementation is still a viable option, as true allergies to IV iron are very rare, and most reactions are complement activation–related pseudo-allergy, which can be managed with corticosteroids or by slowing the infusion rate 1. When treating anemia in patients with an iron allergy, it's crucial to consider the underlying cause of the anemia and the severity of the allergy.
- If the patient has iron deficiency anemia, alternatives to traditional iron supplements may be necessary, such as iron chelated with amino acids or non-iron-containing heme iron polypeptides.
- For patients with other types of anemia, such as B12 or folate deficiency, oral or intravenous supplements of the deficient nutrient may be used.
- In severe cases, blood transfusions may be necessary to rapidly increase red blood cell count.
- Dietary modifications, such as increasing consumption of iron-rich foods and vitamin C to enhance iron absorption, may also be beneficial.
- It's essential to monitor the patient's progress with regular blood tests and adjust the treatment plan as needed. According to a recent expert review on the management of iron deficiency anemia, IV iron is indicated if a patient cannot tolerate oral iron or if blood counts or iron stores do not improve with oral iron supplementation 1.
- The review also notes that IV iron formulations that can replace iron deficits with 1 to 2 infusions are preferred due to their convenience and similar efficacy to other formulations.
- Additionally, the review suggests that corticosteroids may be beneficial in managing more severe reactions to IV iron, while diphenhydramine should be avoided due to its potential side effects 1.
From the Research
Treatment Options for Anemia in Patients Allergic to Iron
- Desensitization is a safe and effective treatment option for iron-deficient anemic patients who require intravenous iron despite their hypersensitivity to iron 2, 3.
- Desensitization procedures can prevent treatment discontinuation and allow therapeutic target achievement in patients with iron allergy 2.
- Intravenous iron therapy is widely used when oral iron preparations are either not tolerated or ineffective, and it improves iron stores more rapidly 2, 4.
- Erythropoiesis stimulating agents are exogenous erythropoietin medications that can be used to stimulate the bone marrow red blood cells' production for the management of anemia 5, 6.
- These agents have different clinical characteristics and stabilities due to their chemical modifications, and their effectiveness varies depending on individual patient characteristics and etiologies of anemia 5.
Considerations for Treatment
- The treatment of anemia depends on hemoglobin levels of individual patients, and physicians must follow patients during and after therapy using erythropoiesis stimulating agents 5.
- The risks and benefits of erythropoiesis stimulating agents must be carefully considered in the management of anemia to achieve maximum efficacy for anemic patients 5.
- New intravenous iron preparations, such as ferumoxytol and ferric carboxymaltose, have been developed and may be used in patients with iron deficiency anemia 6.