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Intravenous Iron Therapy: Re-administration after Prior Adverse Reaction
Aung Tim,Thein Hla,Aung Sandy Tin,Soe Benjamin Tin Aung,Ohnmar Ei 대한가정의학회 2023 Korean Journal of Family Medicine Vol.44 No.6
Background: Intravenous (IV) iron therapy is performed in community practices and hospitals with modern for-mulations when oral administration becomes impractical. Effective replacement of iron is important for the treat-ment of iron deficiency and anemia. Can IV iron be rechallenged in individuals with a history of adverse reactions? This review is to explore the challenge of this, when clinically indicated.Methods: After performing a literature search, five studies (combined total sample number=1,006) for re-exposure of IV iron to individuals with a history of past reactions were identified, observed, and analyzed. Re-exposure in-cluded reactions ranging from mild to moderate and few cases of severe type.Results: The majority (>80%) of IV iron rechallenges were tolerable, safe, and successful without major serious inci-dents. There were no reports of major reactions (severe hypersensitivity reactions or anaphylaxis) in these re-expo-sures.Conclusion: Re-administration of IV iron therapy in patients with a previous adverse reaction is plausible, with benefit and risk stratification. A rechallenge would depend on the nature and degree of the adverse reaction and use of alternative formulations. Rechallenge to a previous severe hypersensitivity reaction or anaphylaxis with the same product has not been reported in these studies. Evidence on the benefit of premedication use is conflicting and requires further studies.