Iron preparations
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Iron preparations Immediate hypersensitivity with different manifestations: 3 case reports
A case series described three women aged 35–46 years, who developed immediate hypersensitivity reaction manifested as angioedema, dyspnoea, hypotension, pruritus, syncope, urticaria or wheezing following administration of ferric pyrophosphate, ferrous bisglycinate, ferrous gluconate or ferrous sulfate for iron deficiency anaemia. Case 1 (a 35-year-old woman): The woman was diagnosed with iron deficiency anaemia secondary to multiple uterine myomas and atrophic gastritis. Since the age of 18 years, she had been treated with IV ferrous gluconate [Ferlixit; sodium ferric gluconate] 62.5mg daily for 8 days. However, at the age of 35 years, she developed urticaria, dyspnoea, angioedema and fainting during administration of IV infusion of ferrous gluconate. She was emergently treated with unspecified corticosteroids and antihistamines. Administration of ferrous gluconate was therefore stopped. Her treatment was shifted to an oral ferrous bisglycinate [Tecnofer] 14mg daily. At the second administration, she experienced pruritus and mild urticaria. Despite the adverse reaction, ferrous bisglycinate was continued. The third administration resulted into severe urticaria and angioedema. Her treatment was changed to oral ferrous sulfate [ferrous sulfate heptahydrate; Tardyfer] 80mg daily. However, she developed similar symptoms with this treatment as well. She was referred to a clinic, where she underwent skin prick test (SPT) with full-strength solution of sodium ferric gluconate and intradermal test (IDT) with 100-fold and 10-fold dilutions of the full strength solution. Both the tests showed negative results. Based on these results, clinical symptoms, time of onset of the adverse reactions and lack of dependence on the dose administered, an immediate-type hypersensitivity reaction manifested as urticaria, dyspnoea, angioedema, pruritus and fainting was diagnosed. Subsequently, she underwent successful desensitisation and tolerated unspecified iron preparation. Case 2 (a 46-year-old woman): The woman, who was diagnosed with iron deficiency anemia secondary to frequent episodes of metrorrhagia, started receiving iron therapy with IV ferrous gluconate [sodium ferric gluconate; Ferlixit] infusion 62.5mg daily. However, during the third infusion, she developed generalised urticaria and hypotension. Initially, the iron treatment was continued along with premedication such as chlorphenamine and dexamethasone. However, following the fifth administration, she again developed urticaria. She was referred to a clinic where she underwent SPT and IDT. The tests showed negative results. Consequently, based on the results and clinical features, she was diagnosed with an immediate-type hypersensitivity reaction manifested as urticaria and hypotension. Subsequently, she underwent successful desensitization, and then tolerated unspecified iron preparation. Case 3 (a 45-year-old woman): The woman was diagnosed with iron deficiency anaemia secondary
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