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JAMA Network Open Mar 2022Although iron deficiency is common, it remains unclear which iron repletion strategy is associated with the lowest rate of infusion-related adverse events, and how...
IMPORTANCE
Although iron deficiency is common, it remains unclear which iron repletion strategy is associated with the lowest rate of infusion-related adverse events, and how patients with history of infusion reaction should be managed.
OBJECTIVE
To evaluate rates of infusion reactions among 4 commonly used intravenous iron repletion strategies and determine how readministration was managed in patients with history of reaction.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study included all patients receiving intravenous iron infusion from January 1, 2015, to September 7, 2021, at 6 centers in Portland, Oregon. Participants included a total of 12 237 patients with iron deficiency, not restricted by etiology. Statistical analysis was performed from September to October 2021.
EXPOSURES
Type of intravenous iron formulation and concurrent administration of diphenhydramine, epinephrine, famotidine, and/or hydrocortisone, used as surrogate maker of infusion reaction.
MAIN OUTCOMES AND MEASURES
Incidence of adverse events, including severe events requiring epinephrine, stratified by type of iron formulation, and in patients who received premedication or with history of infusion-related reaction receiving subsequent doses.
RESULTS
Among 35 737 unique iron infusions (12 237 patients [9480 (77.5%) women; 717 (5.9%) Black; 10 250 (83.7%) White; mean (SD) age of 51 (20) years]), comprising 22 309 iron sucrose doses, 9067 iron dextran total doses (1771 preceded by test dose, 56 test doses alone), 3147 ferumoxytol doses, and 1214 ferric carboxymaltose doses, incidence of adverse events was 3.9% (n = 1389; 95% CI, 3.7%-4.1%). Rate of infusion events differed among iron formulations: 4.3% (n = 970; 95% CI, 4.1%-4.6%) iron sucrose, 3.8% (n = 345, 95% CI: 3.4%-4.2%) iron dextran (test and full doses or test dose alone), 1.8% (n = 57; 95% CI, 1.4%-2.3%) ferumoxytol, and 1.4% (n = 17, 95% CI, 0.8%-2.3%) ferric carboxymaltose (P < .001). Severe adverse events were exceedingly rare with only 2 documented epinephrine administrations, both associated with iron dextran. Incidence of adverse events among those who received premedication was 23-fold higher compared with those who did not (38.6% vs 1.7%, χ21 = 7324.8; P < .001). Among 873 patients with history of infusion reaction who underwent readministration, the majority received the same formulation, which was associated with significantly higher reaction rate particularly if premedication was administered (68% [95% CI, 64%-72%] vs 32% [95% CI, 26%-41%], respectively), compared with those who received an alternate formulation (21% [95% CI, 11%-35%] vs 5% [95% CI, 2%-12%], respectively) (P < .001).
CONCLUSIONS AND RELEVANCE
These data, and the preponderance of published evidence, suggest that intravenous iron is generally well tolerated with exceedingly low risk of severe reaction, use of premedication and test doses are unnecessary, and that optimal prevention and management of infusion-related reactions warrant further study.
Topics: Administration, Intravenous; Adult; Cohort Studies; Female; Ferrosoferric Oxide; Humans; Infusions, Intravenous; Iron; Male; Middle Aged
PubMed: 35353168
DOI: 10.1001/jamanetworkopen.2022.4488 -
Qatar Medical Journal 2023Anaphylaxis is a fatal condition that can be easily managed if discovered early. Only a few examples of anaphylaxis-like reactions caused by heparin have been...
Anaphylaxis is a fatal condition that can be easily managed if discovered early. Only a few examples of anaphylaxis-like reactions caused by heparin have been documented, and immediate-type hypersensitivity reactions to heparin are extremely uncommon. We report a case of a 53-yearold gentleman known to have an End Stage Renal Disease (ESRD) on Hemodialysis for two years, who went to the dialysis facility in his usual state of health. After two hours of dialysis, a new lock of taurolidine/heparin was installed; one minute later, the patient started to vomit and became restless, blood pressure dropped to 60/47 mmHg, and urticarial hives and a reddish rash developed on his skin, covering his trunk and limbs. He was immediately given three doses of epinephrine intramuscularly, which he did not respond to. Therefore, an epinephrine infusion was started. IV hydrocortisone and diphenhydramine were given for symptomatic relief. The patient was shifted to the emergency department, where he became vitally stable and returned to baseline. Heparininduced anaphylaxis was assumed based on the quick response to the above medications. This case can be added to the growing literature regarding this rare reaction, and more studies should be done to understand the nature of the reaction better. We recommend that the healthcare team becomes vigilant of heparin as a possible cause of anaphylaxis.
PubMed: 38025316
DOI: 10.5339/qmj.2023.sqac.17 -
Cureus Nov 2022Management of psychiatric disorders in high-risk cardiac patients often requires difficult decision making when it comes to acceptable medication side effects. We...
Management of psychiatric disorders in high-risk cardiac patients often requires difficult decision making when it comes to acceptable medication side effects. We present the case report of a 28-year-old female with a history of generalized anxiety disorder (GAD), major depressive disorder (MDD), intravenous heroin use disorder, and prior tricuspid valve replacement who presented to the hospital with signs and symptoms of sepsis. She was found to have corrected QT interval (QTc) prolongation and infective endocarditis with blood cultures positive for . Due to QTc prolongation, her home medication of citalopram was discontinued in favor of escitalopram. Within 24 hours of administration, the patient experienced angioedema with periorbital swelling, lip swelling, and urticaria of the face and arms which was resolved with intravenous (IV) diphenhydramine. In this case report, we present what we believe to be the first recorded case of escitalopram-induced angioedema in a patient without a past medical history of hereditary angioedema (HAE), and how pharmacogenomic testing influenced antidepressant medication selection.
PubMed: 36540519
DOI: 10.7759/cureus.31600 -
Frontiers in Endocrinology 2024Diabetic Nephropathy (DN) is one of the microvascular complications of diabetes. The potential targets of renin-angiotensin-aldosterone system (RAAS) inhibitors for the...
Network pharmacology combined with Mendelian randomization analysis to identify the key targets of renin-angiotensin-aldosterone system inhibitors in the treatment of diabetic nephropathy.
BACKGROUND
Diabetic Nephropathy (DN) is one of the microvascular complications of diabetes. The potential targets of renin-angiotensin-aldosterone system (RAAS) inhibitors for the treatment of DN need to be explored.
METHODS
The GSE96804 and GSE1009 datasets, 729 RAAS inhibitors-related targets and 6,039 DN-related genes were derived from the public database and overlapped with the differentially expressed genes (DN vs. normal) in GSE96804 to obtain the candidate targets. Next, key targets were screened via the Mendelian randomization analysis and expression analysis. The diagnostic nomogram was constructed and assessed in GSE96804. Additionally, enrichment analysis was conducted and a 'core active ingredient-key target-disease pathway' network was established. Finally, molecular docking was performed.
RESULTS
In total, 60 candidate targets were derived, in which and were screened as the key targets and had a causal association with DN as the protective factors ( < 0.05, OR < 1). Further, a nomogram exhibited pretty prediction efficiency. It is indicated that Benadryl hydrochloride might play a role in the DN by affecting the pathways of 'cytokine cytokine receptor interaction', etc. targeting the . Moreover, might be involved in 'ECM receptor interaction', etc. for the effect of NSAID, captopril, chlordiazepoxide on DN. Molecular docking analysis showed a good binding ability of benadryl hydrochloride and , NSAID and . , , and are causally associated with acute kidney injury.
CONCLUSION
and were identified as key targets for RAAS inhibitors in the treatment of DN, which might provide some clinical significance in helping to diagnose and treat DN. Among the targets of RAAS inhibitors, PTGS2, ITGA4 and ANPEP have a causal relationship with acute kidney injury, which is worthy of further clinical research.
Topics: Humans; Diabetic Nephropathies; Renin-Angiotensin System; Molecular Docking Simulation; Mendelian Randomization Analysis; Network Pharmacology; Cyclooxygenase 2; Acute Kidney Injury; Anti-Inflammatory Agents, Non-Steroidal; Diphenhydramine; Diabetes Mellitus
PubMed: 38332893
DOI: 10.3389/fendo.2024.1354950