A 67-year-old woman with
iron deficiency anemia required parenteral
iron therapy and was treated with intravenous
ferric gluconate. She tolerated the first dose, but after the second dose, she developed a tingling feeling all over her body, along with swelling in her hands and feet, and a
rash with
hives over most of her body. It was thought that she had likely experienced a
hypersensitivity reaction to
ferric gluconate. The decision was made to continue
therapy; however, two modifications were made. The patient was given
dexamethasone,
diphenhydramine, and
ibuprofen 1 hour before administering the third dose, and the infusion time was prolonged by 1 hour. Approximately 45 minutes after the infusion was completed, the patient developed
hives on her arms and legs. At the patient's next
clinic visit, it was decided that continuation of parenteral
iron repletion was necessary, and the decision was made to attempt a challenge with
iron sucrose. The patient was given
dexamethasone 8 mg to be taken the night before and the morning of treatment. She successfully completed the
iron repletion
therapy with
iron sucrose. Three parenteral
iron products are available in the United States:
iron dextran,
sodium ferric gluconate complex, and
iron sucrose.
Iron dextran, the oldest of these products, carries the highest risk for
hypersensitivity reactions. Available data suggest that either
iron sucrose or
ferric gluconate can be safely administered to patients with known
hypersensitivity to
iron dextran. Our patient's experience implies that it may be possible to safely administer
iron sucrose to a patient with
hypersensitivity to
ferric gluconate. This finding has clinical implications and warrants confirmation in a larger population.