Deferoxamine


Specific iron chelating agent used in the treatment of hemochromatosis and acute iron poisoning.
 
Incidence
High.
 
Clinical manifestations
General: anaphylactic shock
 
Respiratory: bronchospasm, hypersensitivity pneumonitis, laryngospasm.
 
Cutaneous: pruritus, urticaria.
 
Diagnostic methods
Cutaneous testing: false positive.
 
No IgE antibodies excepted in lung biopsies.
 
Mechanisms
Direct non-immunological activation of the dermal mast cells (subcutaneous route).
 
Management
Numerous desensitization protocols have been published in adults and children; by intravenous or subcutaneous route.
 
For example in adults:
  • Starting with a dose of 0.015 mg in 50 cc for 30 minutes, gradually increase (6 hours) to 1 500 mg in 50 cc for 30 minutes.
     
  • Then administer 1 500 mg per day by continuous infusion for 4 days.
     
  • Then 1 500 mg per 12 hours for 2 weeks.
     
  • Finally, 1 500 mg every 2 days.
High dose intravenous deferoxamine delivery is highly effective, but can lead to severe hypersensitivity pneumonitis.
 
Other iron chelators (oral deferiprone) are under clinical evaluation.

References

  1. La Rosa M, Romeo M.A, Di Gregorio F, Russo G, "Desensitization treatment for anaphylactoid reactions to desferrioxamine in a pediatric patient with thalassemia", J. Allergy. Clin. Immunol, 1996; 97: 127-8
  2. Lombardo T, Ferro G, Frontini V, Percolla S, "High dose intravenous desferrioxamine (DFO) delivery in four thalassemic patients allergic to subcutaneous DFO administration", Am. J. Hematol., 1996; 51 (1): 90-2
  3. Shalit M, Tedeschi A, Miadonna A, Levy-Shaffer A, "Desferal (desferrioxamine)-a novel activator of connective tissue-type mast cells", J. Allergy. Clin. Immunol, 1991; 87: 854-60
  4. Bousquet J, Navarro M, Robert G, Aye P, Michel F.B, "Rapid desensitization for desferrioxamine anaphylactic reaction", Lancet., 1983; ii: 859-60
  5. Miller K.B, Rosenwasser L.J, Bessette J.M, "Rapid desensitization for desferrioxamine anaphylactic reaction", Lancet., 1981; i: 1059

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.