Premedication for Fe infusion

Q: A 32-year-old female is prescribed intravenous (IV) iron by the hematology service in the ICU. The patient has a mild history of childhood asthma in the remote past. It would be important to premedicate with diphenhydramine (benadryl).

A) Yes

B) No

Answer: B

Premedication with diphenhydramine for iron deficiency anemia is associated with an increased likelihood of an infusion reaction and is not recommended to either treat or prevent the reaction from iron infusion. Diphenhydramine may cause hypotension, somnolence, flushing, dizziness, irritability, nasal congestion, wheezing, and supraventricular tachycardia (SVT).

In usual cases, including a mild history of asthma, no premedication is required. The best approach is to give infusion slowly. For patients who are at high risk of reaction, asthma,  inflammatory arthritis, and multiple drug allergies, premedication with steroids and an H2 blocker should be sufficient.

#allergy

#hematology

References:

1. Rampton D, Folkersen J, Fishbane S, et al. Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica 2014; 99:1671.

2. Arastu AH, Elstrott BK, Martens KL, et al. Analysis of Adverse Events and Intravenous Iron Infusion Formulations in Adults With and Without Prior Infusion Reactions. JAMA Netw Open 2022; 5:e224488.