Use of intravenous iron and risk of anaphylaxis: A multinational observational post-authorisation safety study in Europe

PURPOSE

This post-authorisation safety study estimated the risk of anaphylaxis in patients receiving intravenous (IV) iron in Europe, with interest in iron dextran and iron non-dextrans. Studies conducted in the United States have reported risk of anaphylaxis to IV iron ranging from 2.0 to 6.8 per 10 000 first treatments.

METHODS

Cohort study of IV iron new users, captured mostly through pharmacy ambulatory dispensing, from populations covered by health and administrative data sources in five European countries from 1999 to 2017. Anaphylaxis events were identified through an algorithm that used parenteral penicillin as a positive control.

RESULTS

A total of 304 210 patients with a first IV iron treatment (6367 iron dextran), among whom 13-16 anaphylaxis cases were identified and reported as a range to comply with data protection regulations. The pooled unadjusted incidence proportion (IP) ranged from 0.4 (95% confidence interval [CI], 0.2-0.9) to 0.5 (95% CI, 0.3-1.0) per 10 000 first treatments. No events were identified at first dextran treatments. There were 231 294 first penicillin treatments with 30 potential cases of anaphylaxis (IP = 1.2; 95% CI, 0.8-1.7 per 10 000 treatments).

CONCLUSION

We found an IP of anaphylaxis from 0.4 to 0.5 per 10 000 first IV iron treatments. The study captured only a fraction of IV iron treatments administered in hospitals, where most first treatments are likely to happen. Due to this limitation, the study could not exclude a differential risk of anaphylaxis between iron dextran and iron non-dextrans. The IP of anaphylaxis in users of penicillin was consistent with incidences reported in the literature.

[Experience in the use of data of air quality monitoring networks]

An evaluation of environmental data for use in epidemiologic studies has been made, based on the experience of air pollution monitoring networks management. Univocal criteria are necessary for networks project and their management to have comparable data, underlining the importance of Quality Insurance Control Laboratories. Data elaborations to verify the Air Quality Standards observance are often not sufficient for exposure assessment. Some methods to explain to general populations environmental phenomena are shown from an experience carried out recently in Reggio Emilia and Milan. Finally, it is emphasised the importance to establish a cooperation between air pollution network managers and the data users to understand the representativeness and the correct use of data from monitoring systems.