What is intravenous? immunoglobulin?
Intravenous immunoglobulin (IVIG) is a blood product derived from the combination plasma approximately 10,000 to 20,000 individuals. It is highly purified from plasma by fractionation of cold alcohol. most of immunoglobulins in IVIG they are of the IgG subtype, but there are small and variable amounts of IgA.
What are the indications for intravenous immunoglobulin?
IVIG is used to prevent or reduce the severity of infections in people with immunodeficiency. Provides the body antibodies to protect against bacteria and viruses. In addition, IVIG can also neutralize autoantibodies (antibodies directed against oneself) and therefore can be used to treat a variety of autoimmune disorders
It is approved by the United States Food and Drug Administration (FDA) for the treatment of 7 conditions.
- Chronic Inflammatory Demyelinating polyneuropathy (PDIC)
- Immune thrombocytopenic Purple (ITP)
- Primary immunodeficiency states
- Secondary immunodeficiency in chronic Lymphocytic Leukemia
- Pediatric human immunodeficiency virus (HIV) infection
- Kawasaki syndrome
- Graft prevention vs Host disease in an adult bone marrow recipient transplant
The first four conditions represent the 70% of IVIG use [1].
However, given IVIG's broad action, it can also be used off-label to treat a variety of other conditions. Most of the disorders listed in the table below have documented effectiveness IVIG in a small number of patients in uncontrolled studies.
| Primary immunodeficiency states | Secondary immunodeficiency states |
|---|---|
|
|
| Hematological disorders. | Renal and vasculitic disorders |
|
|
| Neuromuscular disorders | Sensitization to HLA antigens before transplant |
|
|
| Respiratory disorders | Skin diseases |
|
|
The use of IVIG in these and other conditions requires further evaluation using randomization. double-blind placebo-Controlled tests.
IVIG for skin diseases
Dermatological conditions represent a small proportion of total IVIG use, but it is an indication of rapid growth for use. Although IVIG has been used to treat various dermatological diseases, it should be noted that its effectiveness has only been demonstrated through the treatment of small and mostly uncontrolled study groups. The exception is the use of IVIG in the treatment of dermatomyositis, where several clinical studies have been conducted, including a randomized, double-blind, placebo-controlled trial.
The use of IVIG in these and other skin conditions requires further evaluation using randomized double-blind, placebo-controlled trials.
IVIG in dermatomyositis
The basis of dermatomyositis treatment generally involves oral corticosteroids alone or in combination with an immunosuppressive agent such as methotrexate, azathioprine, cyclophosphamide, and cyclosporine. All of these medications have significant side effects, and a less than adequate response is often achieved with this conventional therapy.
IVIG is a useful additional therapy for dermatomyositis patients who do not respond to conventional treatment or who experience unacceptable side effects. A dose of 1-2 g / kg per month administered over two days or 5 days of each month is recommended (currently there is no apparent difference in efficacy between the 2-day and 5-day regimen). A summary of clinical trials shows an overall response rate of 80% at approximately two months, with a maximum response at four months. Most patients require ongoing IVIG therapy along with conventional treatments administered in lower and better tolerated doses.
With the treatment of other skin conditions, IVIG should also be used as additional therapy. A review of all reported cases of IVIG use in dermatological diseases showed that efficacy is much more significant when IVIG is used as adjunctive therapy, with a response rate of 88% compared to 46% when used alone.3
How is intravenous immunoglobulin administered?
IVIG is given as an infusion into a vein over a period of time, usually 2 to 24 hours. How often it is given depends on the underlying condition and varies from once a day to once every 3 to 4 weeks. The dose is typically a total of 2 g / kg of body weight administered over 2 to 5 days.
How long do the effects of IVIG last?
The duration of IVIG response depends on the individual metabolism and the state of the disease. On average, the effects of IVIG can last up to a month after each administration.
IVIG infection risk
The donor pool is carefully screened to eliminate anyone with abnormal liver function or exposure to viruses hepatitis or HIV infection. The IVIG collection process itself removes viruses and bacteria from the plasma. Therefore, IVIG should not present any risk of transmission of hepatitis C, hepatitis B, or HIV. Since the introduction of new techniques to obtain IVIG in 1987, there have been no cases of transmission of these viruses.
What are the precautions when taking intravenous immunoglobulin?
Although immunoglobulins are antibodies in human plasma, people with certain conditions should use this medication with caution. The following medical conditions warrant a discussion with your doctor:
- Previous blood clots
- Dehydration
- Diabetes
- Nephropathy
- Heart disease
- Race
- Pregnant or contemplating pregnancy.
- Breast-feeding.
Who should not receive intravenous immunoglobulin?
IVIG should be avoided by:
- Individuals who have a allergy to immunoglobulins or any other part of this medicine
- Individuals with IgA deficiency: IgA deficiency occurs in approximately 1 in 700 of the population and should be examined before IVIG therapy is instituted.
Side effects of intravenous immunoglobulin.
The side effects of IVIG therapy are generally mild and self-limiting. The most common side effects occur 30–60 minutes after the start of the infusion and include:
- Redness
- Urticaria
- Headache
- Cold
- Fever
- Nausea or vomiting
- Wheezing
- Low back pain
- Tachycardia (fast beats)
- Changes in blood pressure.
- Myalgia (Muscle pain).
These symptoms can be managed by stopping the infusion, or a patient can be premedicated with antihistamines and intravenous hydrocortisone.
Other rare side effects include:
- Acute renal insufficiency
- Blood clots
- Hemolysis (destruction of red blood cells)
- Neutropenia (low white blood cell count).
Which are the Adverse reactions on the skin?
Skin reactions to IVIG are rare, and the exact incidence is unknown. Of all the reported eruptions, a blistering type of eczema it is the most common (a type of dermatitis) [2]. It often begins around 8 to 10 days after IVIG exposure. the eruption It characteristically begins as dyshidrotic eczema (pompholyx) with small itchy blisters on the palms, but this may be followed by a generalized eczematous eruption that extends throughout the body. The affected individual may become erythrodermic (red everywhere) and pruritus (which produces itching).
Skin lesions often resolve within 1 to 4 weeks. The use of current steroids or systemic Steroids control symptoms and can speed recovery.
Other skin reactions include:
- Urticaria
- Maculopapular rash (a typical morbilliform drug rash)
- Lichenoid rash (like lichen planus)
- Diffuse hair lost
- Cutaneous vasculitis.
What causes the skin reaction to IVIG?
The exact cause of skin reactions to IVIG is unknown. The body's immune system is believed to react to one or more substances within IVIG, such as a stabilizing agent, a part of the immunoglobulin, or T cells. The reaction may differ depending on the batch and type of IVIG since immunoglobulin is obtained from a different group of individuals.
What happens to re-exposure to IVIG?
When an individual develops a skin reaction to IVIG, a second exposure can cause the rash to appear earlier (usually around 8-10 days after the infusion) and become more extensive. The immune system has developed memory T cells, and subsequent responses are faster and more severe. Changing the IVIG type can cause a less severe reaction.
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