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AUTHORíS REPLY
Year : 2017  |  Volume : 61  |  Issue : 3  |  Page : 216  

Author's reply: Directly observed iron supplementation for control of iron deficiency anemia


1 Assistant Professor, Public Health and Epidemiology, IIHMR University, Jaipur, Rajasthan, India
2 Senior Resident, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Assistant Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
4 Associate Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
5 Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
6 Professor, Centre for Community Medicine, All India Institute of Medical Sciences, and ICCIDD, New Delhi, India

Date of Web Publication15-Sep-2017

Correspondence Address:
Kapil Yadav
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_237_17

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How to cite this article:
Bairwa M, Ahamed F, Sinha S, Yadav K, Kant S, Pandav CS. Author's reply: Directly observed iron supplementation for control of iron deficiency anemia. Indian J Public Health 2017;61:216

How to cite this URL:
Bairwa M, Ahamed F, Sinha S, Yadav K, Kant S, Pandav CS. Author's reply: Directly observed iron supplementation for control of iron deficiency anemia. Indian J Public Health [serial online] 2017 [cited 2019 Oct 18];61:216. Available from: http://www.ijph.in/text.asp?2017/61/3/216/214817

Sir,

We appreciate that the reader's letter [1] has taken great interest in this topic of paramount public health concern in developing countries. It is evident that there are multiple reasons behind iron deficiency anemia in population. The reader described such an interesting and important aspect of iron deficiency anemia. As such cases present atypical presentation of iron deficiency anemia with an infrequent history of chronic urticaria.

The patient with iron deficiency anemia tends to absorb nickel in excess which further aggravates the manifestations of nickel associated urticaria.[2] This reveals an important interaction of iron deficiency with other micronutrient deficiencies. The Government of India also recognized the significance of micronutrients; hence, the micronutrient deficiencies have found considerable space in the recently released India's National Health Policy 2017.

However, the public health importance of the findings needs to be put in the perspective as our paper discusses the effectiveness of directly observed supplementation in prevention and management of anemia.[3] “How the role of nickel sensitivity should also be considered in such scenario?,” authors of letter [1] should provide an explicit explanation for consideration of readers. A study by Antico and Soanareports that this is nickel associated urticaria [4] which responds to iron therapy/supplementation.[2] Available literature is inconclusive to establish the relationship between oral intake of nickel rich foods and nickel allergy syndrome.[5] There is evidence that allergic condition predisposes anemia.[6] Hence, allergy to other nonfood materials or atopic allergy may cause anemia; and there is also a possibility that iron absorption would improve after reduced intake of food allergen.

Authors of the letter should provide details of investigations done to diagnose nickel sensitivity to support their findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Divya VC, Karthikeyan BS. Enhanced nickel sensitivity in iron deficiency anemia. Indian J Public Health 2017;61:220.  Back to cited text no. 1
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2.
Sharma AD. Benefit of iron therapy in the management of chronic urticaria due to nickel sensitivity. Indian J Dermatol 2010;55:407-8.  Back to cited text no. 2
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3.
Bairwa M, Ahamed F, Sinha S, Yadav K, Kant S, Pandav CS, et al. Directly observed iron supplementation for control of iron deficiency anemia. Indian J Public Health 2017;61:37-42.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Antico A, Soana R. Nickel sensitization and dietary nickel are a substantial cause of symptoms provocation in patients with chronic allergic-like dermatitis syndromes. Allergy Rhinol (Providence) 2015;6:56-63.  Back to cited text no. 4
[PUBMED]    
5.
Pizzutelli S. Systemic nickel hypersensitivity and diet: Myth or reality? Eur Ann Allergy Clin Immunol 2011;43:5-18.  Back to cited text no. 5
[PUBMED]    
6.
Drury KE, Schaeffer M, Silverberg JI. Association between atopic disease and anemia in US children. JAMA Pediatr 2016;170:29-34.  Back to cited text no. 6
[PUBMED]    




 

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