SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

11/3/03

Adverse effects of intravenous immunoglobulin therapy

Summary
Intravenous immunoglobulin (IV/Ig) therapy has been used increasingly in a variety of non-immunodeficiency conditions of presumed immunologic pathogenesis. IV/Ig therapy is generally tolerated without serious side effects. However, some adverse effects have been reported as reviewed by Wittstock et al of the Univ. of Rostock in Germany. A prevalence of adverse effects in 11-81% of treatments with IV/Ig has been described in different reports. They described their own study of 117 adults so treated for a variety of neuro-muscular diseases, IV/Ig injected at a rate of 0.4 G/Kg/day. There were adverse events in 43% of treatments. The majority of these were minor and often just asymptomatic laboratory changes. Rash or mild headache was seen in 8 patients, especially when the infusion rate was >10 G/hour. Deep vein thrombosis was seen in 2 patients. The authors concluded that IV/Ig is a generally safe therapy with increased risk in those with renal insufficiency or who are immobilized (predisposing to vascular thromboses).

Reference
Eur Neurol 2003; 50:172-5

Editor's Comments
The experience described above is fairly similar to that described by others using IV/Ig at the rate of 0.4 G/Kg/day for several days. However, some groups infuse IV/Ig at a more rapid rate (e.g. 2.0 G/ Kg/24 hours). Some reports have described no greater incidence of major adverse effects with this more rapid infusion rate, there appears to be greater adverse effects due to the hyper-osmolarity induced by the rapid infusion of added Ig to an already full complement of plasma proteins. Whether cause and effect related, occasional cases of non-infectious meningeal inflammation (manifested as severe headache), and a predisposition to vascular thrombotic events have been reported. A cluster of cases of such vascular thromboses was observed in our institution several years ago. It is unclear whether such adverse events are seen more with the use of particular brands of IV/ Ig. Of note, such complications are rarely reported in those with IV/Ig treatment of individuals with hypogammaglobulinemia. There appears to be no significant transmittal of infectious agents with current IV/Ig therapy in the USA.

<-- BACK