A new study reveals two IV intravenous iron-boosting products that may increase the risk of Anaphylaxis – a severe allergic attack.

Rutgers researchers looked at medical records from a large database of Medicare patients and found that two common intravenous iron supplements have a much higher chance of causing a severe allergic attack.

The study, which was published in the Annals of Internal Medicine, examined the risk of anaphylaxis, a potentially fatal allergic reaction, among older patients who received one of the five most commonly used IV iron formulations to treat iron deficiency.

In patients with iron deficiency anemia who are unable to eat or accept oral iron supplements, IV iron products are often used. The risk of allergy was higher in individuals given iron dextran and ferumoxytol, according to the researchers, than in those given ferric gluconate, iron sucrose, or ferric carboxymaltose.

In the elderly, allergic responses are more common. Those who treat them are baffled as to why iron-boosting formulations can cause severe anaphylaxis, necessitating emergency care and even hospitalization.

“Quantifying the risk of anaphylaxis from current intravenous iron formulations is important because so much is unknown,” says lead author Chintan Dave.

“That led us to compare the risk specifically between five most frequently used products. Our investigation offers an important step forward in understanding this problem.”

According to the study, the risk of anaphylaxis was still very low across all five IV iron formulations, but the data indicates that the highest prevalence was noted for iron dextran, with 10 patients per 10,000 experiencing the severe allergic reaction, and ferumoxytol, with 4 patients per 10,000 experiencing anaphylaxis.

“We conclude by saying that the rates of anaphylaxis were very low with all IV iron products, but three- to eight-fold greater for iron dextran and ferumoxytol compared with iron sucrose,” adds Dave.

The researchers employed advanced statistical approaches and pharmacoepidemiologic techniques to conduct the research, which are specifically designed for assessing the safety and effectiveness of drugs using big observational databases.

They looked through the medical records of roughly 167,000 seniors gathered by Medicare between 2013 and 2018, looking for anaphylactic episodes linked to IV-administered iron formulations.

“Anaphylaxis is just one of many factors to consider when deciding on which IV iron formulation to administer,” adds Dave. “These include not only the risk of anaphylaxis but also other factors such as the clinical indication, number of IV iron administrations required, risk of other adverse reactions and cost.”

“Our findings also provide reassuring data with respect to the risk of anaphylaxis with ferric carboxymaltose, which has seen a rapid increase in use following favorable clinical trial data in a variety of clinical indications,” adds co-lead author Soko Setoguchi.

“By clarifying the risk of this rare, but severe adverse reaction, this information can be used to contribute to the choice of IV iron preparations.”

Source: 10.7326/M21-4009

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