Successful Management of Deferoxamine Hypersensitivity in a Child

Abstract

A 6-year-old boy with sickle cell disease that required frequent blood transfusions experienced repeated anaphylactoid reactions with dyspnea, rhinorrhea, and angioedema within minutes after treatment with intravenous deferoxamine for his iron overload. Pretreatment with prednisone and diphenhydramine (radiocontrast medium protocol) did not prevent these reactions.

Two reports have described successful desensitization in adults with beta-thalassemia who were sensitive to deferoxamine and who were subsequently able to receive it subcutaneously. For our patient, we devised a 9-week protocol that enabled him to receive intravenous deferoxamine overnight via indwelling catheter at 3 day intervals without reactions. After pretreatment with prednisone and diphenhydramine, he was given graduated doses of deferoxamine intravenously in the pediatric intensive care unit. The initial dose was less than 1:10,000 of the target dose, based on body surface area, and was progressively increased by factors of 10, at 15-20 min intervals. Subcutaneous aqueous epinephrine (1:1000) was required to control bronchospasm twice during the desensitization. Routine treatment with terfenadine by mouth and albuterol by metered-dose inhaler was required.

To the best of our knowledge, this is the first reported desensitization with deferoxamine in a child and the first use of the intravenous route in any patient desensitized with deferoxamine.