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Clinical use of intravenous Immunoglobulin in immunodeficient patients

Author(s): Agha Mohammadi A

Journal: Iranian Journal of Pediatrics
ISSN 2008-2142

Volume: 10;
Issue: 1;
Start page: 24;
Date: 2000;
Original page

Intramuscular immunoglobulin products were first used for the prophylaxis of viral diseases, such as measles, infectious hepatitis and poliomyelitis. When the first patient with agammaglobulinemia was described by routine in 1952, it became apparent that immunoglobulin replacement therapy was the treatment of choice for this entity. The intramuscular injections remained the mode of administration for immunodeficiency patients for almost 20 years. In the late sixties it was realized that administration of higher doses of gamma globuline was clinically more effective than administering low doses. As serum levels of IgG within the normal range could not be achieved using products intended for intramuscular use, in the following decades a number of different preparations intended for intravenous use were manufactured and became available. General experience suggests that through (Preinfusion) IgG levels should be maintained at 400-500 mg/dl to achieve satisfactory clinical status. The recommended dose for IVIG replacement in patients with antibody deficiency syndromes is a loading dose of 400-800 mg/kg and subsequent maintenance dose of 350-500 mg/kg every 3-4 weeks. Adverse reactions may be mild, moderate or severe. Mild adverse reactions (Headache, flushing, chills, low back pain, nausea) are often associated with fast infusion rate, and respond rapidly to slowing the infusion. Moderate adverse reactions (Chest pain, wheezing, mild cyanosis), and severe adverse reactions (Bronchoconstriction, severe hypotension, collapse) require the infusion to be discontinued. Antihistamines, hydrocortisone and adrenaline are used as treatment for such adverse reactions. Patients with antibody deficiency and complete absence of IgA, may develop anti-IgA after infusion of immunoglobulin containing IgA, and life-threatening anaphylaxis may occur. Such patients should receive an IgA-free preparation of immunoglobulin. To the present date on immunoglobulin preparation has been found to transmit retroviral infection. However, several preparations have been associated with outbreaks of non-A, non-B hepatitis, including hepatitis C. diagnosis of infection should be based on serum HCV-RNA detection by RT-PCR. Once the immunoglobulin preparation has been selected for a patient, the minimal risks of viral transmission and possible adverse reactions to IVIG therapy should be discussed with parents and patients. Liver transminase concentrations, serum creatinine concentrations, and anti-IgA antibody titers should be measured as baseline and then every six months
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