RESUMO
INTRODUCTION AND OBJECTIVES: Lenalidomide is considered a standard of care in multiple myeloma (MM) Some MM patients will develop delayed hypersensitivity to lenalidomide, which can lead to treatment discontinuation. Desensitization to lenalidomide can help these patients to complete treatment courses. Here, we aimed to review lenalidomide-treated MM patients who developed delayed hypersensitivity-induced rash and were treated with desensitization. METHODS: A retrospective analysis of medical files of MM patients, who were desensitized to lenalidomide due to delayed hypersensitivity rash. Patients were treated between 2018 and 2022 at Hadassah Medical Center, Jerusalem, Israel. RESULTS: Search of patients yielded 16 patients that underwent desensitization to lenalidomide within the study period. The desensitization protocol consisted of a slow, 3-week-long protocol with lenalidomide's target doses of 10, 15, and 25 mg/day. Of the 16 patients, 10 (62.5%) succeeded to complete the protocol and thus were able to complete lenalidomide treatment cycles. One patient with unsuccessful desensitization was subsequently treated with first-generation IMiD thalidomide, with no rash appearing. None of the patients that were treated with desensitization had severe immune-mediated or non-dermatological adverse reactions. CONCLUSIONS: Desensitization to lenalidomide is safe and effective. Discontinuation of lenalidomide in MM patients with delayed hypersensitivity and no contraindication to desensitization should be discouraged. Collaboration between hematologists and allergists is needed.
Assuntos
Exantema , Hipersensibilidade Tardia , Mieloma Múltiplo , Humanos , Lenalidomida/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Estudos Retrospectivos , Exantema/induzido quimicamente , Exantema/terapia , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Tardia/terapiaRESUMO
SARS CoV-2 virus has infected more than 200 million people worldwide and more than 4.4 million in Indonesia. The vaccination program has become one of the solutions launched by many countries globally, including Indonesia, to reduce the transmission rate of COVID-19. Various vaccination platforms are produced, such as inactivated, viral vector, mRNA, and protein subunit. The vaccination booster program with mRNA platform (Moderna) was launched by the Indonesian government to give better protection for health care workers, particularly from delta variant. In this case report, we discuss one of the typical side effects of Moderna vaccine, which is referred to as the COVID arm.
Assuntos
Acetaminofen/administração & dosagem , Vacinas contra COVID-19 , COVID-19/prevenção & controle , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hipersensibilidade Tardia , Pele/patologia , Vacina de mRNA-1273 contra 2019-nCoV , Analgésicos não Narcóticos/administração & dosagem , Biópsia/métodos , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Tardia/fisiopatologia , Hipersensibilidade Tardia/terapia , Reação no Local da Injeção/diagnóstico , Reação no Local da Injeção/etiologia , Reação no Local da Injeção/fisiopatologia , Pessoa de Meia-Idade , Médicos , SARS-CoV-2 , Resultado do Tratamento , Vacinação/métodosRESUMO
Metal hypersensitivity (MHS) and trunnionosis are being looked at more frequently. Both entities pose a difficult concern for surgeons and patients alike. This commentary highlights the similarities and differences between the 2 conditions. When a surgeon suspects either MHS or trunnionosis, both should be considered in the differential diagnosis. Both conditions are rare and should be considered a diagnosis of exclusion. The commentary proposes an outline on how to diagnose and treat the 2 entities.
Assuntos
Artroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Tardia/etiologia , Metais/efeitos adversos , Falha de Prótese/efeitos adversos , Diagnóstico Diferencial , Humanos , Hipersensibilidade Tardia/terapiaRESUMO
Despite the strong evidence for the immunomodulatory activity of mesenchymal stromal cells (MSCs), clinical trials have so far failed to clearly show benefit, likely reflecting methodological shortcomings and lack of standardization. MSC-mediated tissue repair is commonly believed to occur in a paracrine manner, and it has been stated that extracellular vesicles (EVs) secreted by MSCs (EVMSC) are able to recapitulate the immunosuppressive properties of parental cells. As a next step, clinical trials to corroborate preclinical studies should be performed. However, effective dose in large mammals, including humans, is quite high and EVs industrial production is hindered by the proliferative senescence that affects MSCs during massive cell expansion. We generated a genetically modified MSC cell line overexpressing hypoxia-inducible factor 1-alpha and telomerase to increase the therapeutic potency of EVMSC and facilitate their large-scale production. We also developed a cytokine-based preconditioning culture medium to prime the immunomodulatory response of secreted EVs (EVMSC-T-HIFc). We tested the efficacy of this system in vitro and in a delayed-type hypersensitivity mouse model. MSC-T with an HIF-1α-GFP lentiviral vector (MSC-T-HIF) can be effectively expanded to obtain large amounts of EVs without major changes in cell phenotype and EVs composition. EVMSC-T-HIFc suppressed the proliferation of activated T-cells more effectively than did EVs from unmodified MSC in vitro, and significantly blunted the ear-swelling response in vivo by inhibiting cell infiltration and improving tissue integrity. We have developed a long-lived EV source that secretes high quantities of immunosuppressive EVs, facilitating a more standard and cost-effective therapeutic product.
Assuntos
Vesículas Extracelulares/transplante , Hipersensibilidade Tardia/terapia , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Imunomodulação , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/metabolismo , Linfócitos T/imunologia , Animais , Linhagem Celular , Proliferação de Células , Células Cultivadas , Citocinas/farmacologia , Polpa Dentária/citologia , Vesículas Extracelulares/imunologia , Vetores Genéticos/genética , Proteínas de Fluorescência Verde/genética , Proteínas de Fluorescência Verde/metabolismo , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Lentivirus/genética , Masculino , Células-Tronco Mesenquimais/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Engenharia de Proteínas/métodos , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Linfócitos T/fisiologia , Telomerase/genética , Telomerase/metabolismo , Adulto JovemAssuntos
Alérgenos/imunologia , Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/terapia , Hipersensibilidade Tardia/terapia , Lenalidomida/imunologia , Linfócitos T/imunologia , Idoso , Hipersensibilidade a Drogas/diagnóstico , Humanos , Hipersensibilidade Tardia/diagnóstico , Testes Imunológicos , Ativação Linfocitária , Masculino , Resultado do TratamentoRESUMO
Because of their inert character and desired biocompatibility, titanium implants have been universally accepted as safer alternatives to the conventional stainless steel orthopedic implants; however, recent emergence of type IV hypersensitivity reactions to titanium have included eczema, contact dermatitis, a prolonged febrile state, sterile osteonecrosis, and impaired fracture and wound healing. This report presents a patient with postoperative incision dehiscence and devascularization of surfaces in contact with titanium hardware after undergoing a double calcaneal osteotomy and a first metatarsal-cuneiform arthrodesis using titanium alloy implants. Titanium hypersensitivity was confirmed in this case through standard allergy patch testing by a board-certified immunologist. Complete healing occurred after diagnosis of the titanium allergy and hardware explant. To our knowledge, this is one of a few known allergies to titanium implants after foot and ankle surgery.
Assuntos
Artrodese/efeitos adversos , Artrodese/instrumentação , Hipersensibilidade Tardia/etiologia , Ossos do Metatarso/cirurgia , Titânio/efeitos adversos , Adulto , Feminino , Pé Chato/cirurgia , Humanos , Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Tardia/terapia , Osteotomia/efeitos adversos , Ossos do Tarso/cirurgiaRESUMO
Lenalidomide is an immunomodulatory agent that belongs to a family of IMiDs used to treat multiple myeloma. Hypersensitivity and skin reactions are adverse effects of lenalidomide that may lead to discontinuation of its use for multiple myeloma making them contraindicated to other IMiD therapies. Desensitization protocols have been developed to desensitize patients to lenalidomide skin reaction and rash. We report a case series of 5 patients undergoing slow lenalidomide desensitization protocol in an outpatient cancer center setting. Four of the five patients were able to be successfully desensitized to lenalidomide. We also demonstrate safety of using slow lenalidomide desensitization while on combination therapy for control of multiple myeloma.
Assuntos
Dessensibilização Imunológica/métodos , Toxidermias/terapia , Exantema/terapia , Hipersensibilidade Tardia/terapia , Fatores Imunológicos/administração & dosagem , Lenalidomida/administração & dosagem , Mieloma Múltiplo/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer , Relação Dose-Resposta a Droga , Esquema de Medicação , Toxidermias/etiologia , Exantema/induzido quimicamente , Exantema/imunologia , Feminino , Humanos , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Tardia/imunologia , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/imunologia , Lenalidomida/efeitos adversos , Lenalidomida/imunologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/imunologia , Ambulatório Hospitalar , Pele/efeitos dos fármacos , Pele/imunologia , Fatores de Tempo , Resultado do TratamentoAssuntos
Dessensibilização Imunológica , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Hipersensibilidade Tardia/etiologia , Hipersensibilidade Tardia/terapia , Fatores Imunológicos/efeitos adversos , Síndrome POEMS/complicações , Talidomida/análogos & derivados , Idoso , Biomarcadores , Hipersensibilidade a Drogas/diagnóstico , Feminino , Humanos , Hipersensibilidade Tardia/diagnóstico , Fatores Imunológicos/uso terapêutico , Imageamento por Ressonância Magnética , Síndrome POEMS/diagnóstico , Síndrome POEMS/tratamento farmacológico , Talidomida/efeitos adversos , Talidomida/uso terapêutico , Resultado do TratamentoAssuntos
Antineoplásicos Alquilantes/efeitos adversos , Cloridrato de Bendamustina/efeitos adversos , Dessensibilização Imunológica , Hipersensibilidade a Drogas/terapia , Hipersensibilidade Tardia/terapia , Adulto , Hipersensibilidade a Drogas/diagnóstico , Humanos , Hipersensibilidade Tardia/diagnóstico , Masculino , Testes CutâneosRESUMO
Tranexamic acid is an anti-fibrinolytic agent frequently used in pediatric surgery. Common side effects include nausea, flushing, and headache, but in rare instances, it may produce anaphylaxis; with only one previously reported case in a 72-year-old man. We report a case of a delayed anaphylactic reaction in a pediatric patient undergoing posterior spine fusion; and discuss the intraoperative management of the acute event, immunologic confirmation, and subsequent anesthetic approach.
Assuntos
Anafilaxia/etiologia , Anafilaxia/terapia , Antifibrinolíticos/efeitos adversos , Complicações Intraoperatórias/terapia , Fusão Vertebral , Ácido Tranexâmico/efeitos adversos , Adolescente , Anestesia Geral , Anestesia Intravenosa , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Humanos , Hipersensibilidade Tardia/terapia , Masculino , Monitorização Intraoperatória , Testes CutâneosRESUMO
The microenvironment plays a pivotal role for cell survival and functional regulation, and directs the cell fate determination. The biological functions of DCs have been extensively investigated to date. However, the influences of the microenvironment on the differentiation of bone marrow cells (BMCs) into dendritic cells (DCs) are not well defined. Here, we established a 3D collagen scaffold microenvironment to investigate whether such 3D collagen scaffolds could provide a favourable niche for BMCs to differentiate into specialised DCs. We found that BMCs embedded in the 3D collagen scaffold differentiated into a distinct subset of DC, exhibiting high expression of CD11b and low expression of CD11c, co-stimulator (CD40, CD80, CD83, and CD86) and MHC-II molecules compared to those grown in 2D culture. DCs cultured in the 3D collagen scaffold possessed weak antigen uptake ability and inhibited T-cell proliferation in vitro; in addition, they exhibited potent immunoregulatory function to alleviate allo-delay type hypersensitivity when transferred in vivo. Thus, DCs differentiated in the 3D collagen scaffold were defined as regulatory DCs, indicating that collagen scaffold microenvironments probably play an important role in modulating the lineage commitment of DCs and therefore might be applied as a promising tool for generation of specialised DCs.
Assuntos
Células da Medula Óssea/imunologia , Colágeno Tipo I/farmacologia , Células Dendríticas/imunologia , Hipersensibilidade Tardia/terapia , Alicerces Teciduais , Animais , Antígenos CD/genética , Antígenos CD/imunologia , Biomarcadores/metabolismo , Células da Medula Óssea/citologia , Células da Medula Óssea/efeitos dos fármacos , Antígeno CD11b/genética , Antígeno CD11b/imunologia , Antígeno CD11c/genética , Antígeno CD11c/imunologia , Bovinos , Técnicas de Cultura de Células , Diferenciação Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Técnicas de Cocultura , Colágeno Tipo I/isolamento & purificação , Células Dendríticas/citologia , Células Dendríticas/efeitos dos fármacos , Células Dendríticas/transplante , Expressão Gênica , Antígenos de Histocompatibilidade Classe II/genética , Antígenos de Histocompatibilidade Classe II/imunologia , Hipersensibilidade Tardia/imunologia , Hipersensibilidade Tardia/patologia , Camundongos , Camundongos Endogâmicos C57BL , Linfócitos T/citologia , Linfócitos T/imunologia , Tendões/químicaRESUMO
âWe retrospectively reviewed the records of 3 patients (3 knees) with a delayed type hypersensitivity reaction following Dermabond exposure after an orthopaedic knee procedure. Delayed hypersensitivity reactions are mediated by CD4+ helper T cells. The use of skin adhesives in place of traditional sutures is increasing in popularity given Dermabond's potential benefits of decreased wound infection rate and better wound approximation. However, hypersensitivity reactions to the cyanoacrylate material in Dermabond have been described. Differentiating hypersensitivity reactions from post-operative infections is important as septic arthritis is a potentially devastating complication. This case series presents the challenge of properly diagnosing and managing hypersensitivity reactions. Consultation with allergists and dermatologists may be appropriate for ascertaining the nature of the surgical site complication and proper management. The recommended management of hypersensitivity-type reactions is a course of topical steroids and infection work up if needed.
Assuntos
Adesivos/efeitos adversos , Cianoacrilatos/efeitos adversos , Hipersensibilidade Tardia/diagnóstico , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Adesivos Teciduais/efeitos adversos , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Hipersensibilidade Tardia/etiologia , Hipersensibilidade Tardia/terapia , Infecções/diagnóstico , Traumatismos do Joelho/cirurgia , Masculino , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , SuturasAssuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Capecitabina/efeitos adversos , Neoplasias do Colo/tratamento farmacológico , Dessensibilização Imunológica/métodos , Toxidermias/terapia , Hipersensibilidade Tardia/terapia , Pele/efeitos dos fármacos , Idoso , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/imunologia , Capecitabina/administração & dosagem , Capecitabina/imunologia , Neoplasias do Colo/patologia , Esquema de Medicação , Toxidermias/diagnóstico , Toxidermias/imunologia , Humanos , Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Tardia/imunologia , Tolerância Imunológica , Testes Intradérmicos , Masculino , Pele/imunologia , Pele/patologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Current treatments to control pathological or unwanted immune responses often use broadly immunosuppressive drugs. New approaches to induce antigen-specific immunological tolerance that control both cellular and humoral immune responses are desirable. Here we describe the use of synthetic, biodegradable nanoparticles carrying either protein or peptide antigens and a tolerogenic immunomodulator, rapamycin, to induce durable and antigen-specific immune tolerance, even in the presence of potent Toll-like receptor agonists. Treatment with tolerogenic nanoparticles results in the inhibition of CD4+ and CD8+ T-cell activation, an increase in regulatory cells, durable B-cell tolerance resistant to multiple immunogenic challenges, and the inhibition of antigen-specific hypersensitivity reactions, relapsing experimental autoimmune encephalomyelitis, and antibody responses against coagulation factor VIII in hemophilia A mice, even in animals previously sensitized to antigen. Only encapsulated rapamycin, not the free form, could induce immunological tolerance. Tolerogenic nanoparticle therapy represents a potential novel approach for the treatment of allergies, autoimmune diseases, and prevention of antidrug antibodies against biologic therapies.
Assuntos
Antígenos/administração & dosagem , Antígenos/química , Tolerância Imunológica , Terapia de Imunossupressão/métodos , Nanopartículas/química , Animais , Linfócitos T CD4-Positivos/imunologia , Modelos Animais de Doenças , Encefalomielite Autoimune Experimental/imunologia , Encefalomielite Autoimune Experimental/prevenção & controle , Encefalomielite Autoimune Experimental/terapia , Fator VIII/imunologia , Feminino , Hemocianinas/administração & dosagem , Hemofilia A/imunologia , Hemofilia A/terapia , Humanos , Hipersensibilidade Tardia/imunologia , Hipersensibilidade Tardia/terapia , Imunidade Humoral , Imunossupressores/administração & dosagem , Ácido Láctico/química , Camundongos , Camundongos Endogâmicos BALB C , Nanocápsulas/administração & dosagem , Nanocápsulas/química , Nanopartículas/administração & dosagem , Oligodesoxirribonucleotídeos/administração & dosagem , Ovalbumina/administração & dosagem , Ovalbumina/imunologia , Fragmentos de Peptídeos/administração & dosagem , Fragmentos de Peptídeos/imunologia , Peptídeos/administração & dosagem , Peptídeos/química , Peptídeos/imunologia , Ácido Poliglicólico/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Proteínas/administração & dosagem , Proteínas/química , Proteínas/imunologia , Proteínas Recombinantes/imunologia , Sirolimo/administração & dosagemRESUMO
BACKGROUND: Induction of delayed hypersensitivity reactions by red tattoos has been occasionally reported. Little is known about the inks used. Azo pigments have been implicated in some instances, but there is only one reported case involving quinacridones. OBJECTIVES: To describe the clinical and pathological features and outcome of skin reactions induced by red tattoo pigments. PATIENTS, MATERIALS, AND METHODS: Six patients with a cutaneous reaction induced by a red tattoo pigment underwent biopsy and prick and patch testing with the inks supplied. RESULTS: We observed seven reactions in the 6 patients. Histology showed various patterns: three lichenoid, two eczematous, and two pseudolymphomatous. Five reactions occurred with azo pigments, and two with quinacridones, in both cases with Violet 19 and Red 122. Four inks were tested. Only one patch test gave a positive result at a late reading (day 7). Prick tests gave negative results. The reactions required various treatments, including laser treatment for 2 patients. Activation of the reaction in 1 case was transient. CONCLUSION: Azo pigments and quinacridones both triggered reactions with similar clinical aspects but with varying histological findings. Patch and prick test results were disappointing with both. Reactions occurred following laser use in 1 case.
Assuntos
Compostos Azo/efeitos adversos , Corantes/efeitos adversos , Compostos Heterocíclicos de 4 ou mais Anéis/efeitos adversos , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Tardia/patologia , Tinta , Tatuagem/efeitos adversos , Adulto , Biópsia , Feminino , Humanos , Hipersensibilidade Tardia/terapia , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Testes do EmplastroRESUMO
BACKGROUND: Chemotherapy is one of the main treatments for lung cancer, and in these patients, discontinuation of treatment due to uncontrollable hypersensitivity reactions (HSRs) is an important problem. AIM: To determine the frequency of HSRs during chemotherapy and to review current approaches. METHODS: We did a cross sectional study in patients undergoing chemotherapy for lung cancer in a reference chemotherapy unit from January 2012 to January 2013. Patients who developed immediate-HSRs or delayed-HSRs to chemotherapeutics and gave consent were included into study. The effectiveness of a standardised 12-step "rapid drug desensitisation" (RDD) procedure was investigated in patients with immediate-HSRs. RESULTS: In total, 1,099 cycles of chemotherapy were administered to 292 patients in 1 year. We observed ten HSRs, during ten cycles in ten patients (~3 % of the patients). Two HSRs were delayed-type, eight were immediate-type at grade 1-3. Of those with immediate-type HSR, five patients with grade 2-3, and additional two referred patients with grade 4 HSRs were successfully given their culprit drug in 35 cycles of chemotherapy with 12-step or modified 20-step RDD protocol. CONCLUSIONS: HSRs to chemotherapeutics are not so rare. Premedication alone does not prevent such reactions. The results of RDD treatment look promising for continuing treatment with the culprit chemotherapeutic agent.
Assuntos
Antineoplásicos/efeitos adversos , Dessensibilização Imunológica/métodos , Toxidermias/terapia , Hipersensibilidade Tardia/terapia , Hipersensibilidade Imediata/terapia , Neoplasias Pulmonares/tratamento farmacológico , Adulto , Idoso , Carboplatina/efeitos adversos , Estudos Transversais , Docetaxel , Toxidermias/etiologia , Etoposídeo/efeitos adversos , Feminino , Humanos , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Imediata/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Pemetrexede/efeitos adversos , Testes Cutâneos , Taxoides/efeitos adversosAssuntos
Antineoplásicos Alquilantes/efeitos adversos , Dacarbazina/análogos & derivados , Dessensibilização Imunológica , Toxidermias/terapia , Hipersensibilidade Tardia/terapia , Hipersensibilidade Imediata/terapia , Adulto , Dacarbazina/efeitos adversos , Toxidermias/etiologia , Humanos , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Imediata/induzido quimicamente , Masculino , TemozolomidaRESUMO
BACKGROUND: Delayed reactions associated with dermal fillers have often been attributed to hypersensitivity reactions; however, the evolving literature suggests that biofilms may represent an underrecognized cause and a difficult diagnosis to establish. As implanted devices become more popular, biofilms present an increasing risk to patients. OBJECTIVE: The mechanism of action for biofilm formation, diagnostic challenges, and methods to recognize biofilms will be reviewed. These are increasingly important for physicians who implant these devices and for those who see patients with implanted devices. METHODS: We review the relevant literature and explore some of these issues. CONCLUSION: Preventative measures may decrease delayed reactions and biofilm formation after injection of dermal fillers. Infection through biofilms should be considered and carefully evaluated to ensure timely treatment.
Assuntos
Biofilmes , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Tardia/terapia , Próteses e Implantes/efeitos adversos , Antibacterianos/uso terapêutico , Materiais Biocompatíveis/efeitos adversos , Humanos , Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Tardia/prevenção & controleRESUMO
In the last several years, intravenous therapy with iron products has been more widely used. Although it has been a standard procedure in dialysis-associated anemia since the early 1990s, its use is expanding to a host of conditions associated with iron deficiency, especially young women with heavy uterine bleeding and pregnancy. Free iron is associated with unacceptable high toxicity inducing severe, hemodynamically significant symptoms. Subsequently, formulations that contain the iron as an iron carbohydrate nanoparticle have been designed. With newer formulations, including low-molecular-weight iron dextran, iron sucrose, ferric gluconate, ferumoxytol, iron isomaltoside, and ferric carboxymaltose, serious adverse events are rare.