Are pre-medications required for IV iron empirically in a patient with a history of anaphylaxis unrelated to the IV iron?¶
Answer: Although a history of other allergies increases the risk of adverse reactions, routine pre-medication is not recommended.
- There is no evidence that pre-medication reduces the rate of a first reaction to IV iron. The panel instead advises a slow initial infusion rate for patients with risk factors or a first dose, and a lower dose in selected patients:
In patients with identified risk factors for hypersensitivity reactions, or in those receiving a first dose, the panel concurred that the infusion should be initiated at a slow infusion rate to minimize the risk of a reaction. In accordance with existing guidance documents that suggest initiating infusions at low rates (<50% of recommended rate), increasing it after a few minutes if no infusion reaction occurs, we also recommend using an initially slow infusion rate, particularly during the first infusion.
In addition to increasing the infusion time, the panel also noted that lower doses of IV iron are associated with lower rates of hypersensitivity reactions. Thus, in selected patients with identified risk factors for hypersensitivity reactions or previous isolated symptoms, a lower dose may be considered based on expert opinion.
- Test doses are not recommended based on post-marketing data; a successful test dose may give false assurance to the healthcare team.
Source: Canadian expert consensus: management of hypersensitivity reactions to intravenous iron in adults