Intravenous immunoglobulin

A solution of human plasma derived immunoglobulin containing extensive range of immune antibodies that may protect against human pathogens or antigens.

Effective therapy for Guillain-Barre syndrome, multifocal motor neuropathy, dermatoyositis, myasthenia gravis, Eaton-Lambert syndrome, stiff-person syndrome, ITP and demyelinating polyradiculoneuropathy.

Conditions approved by the FDA include: chronic inflammatory delineating polyneuropathy, chronic lymphocytic leukemia, prevention for graft versus host disease, HIV infection, immuno deficiencies, hepatic thrombocytopenic purpura, and Kawasaki syndrome.

Off label uses include: Agammaglobulinemia, anti-factor VIII antibodies, autoimmune neutropenia, common variable immunodeficiency, congenital hypergammaglobulinemia, Guillain-Barre syndrome, ITP, Isoimmune thrombocytopenia, lupus, myasthenia gravis, nephropathy, parvovirus B 19 infection, severe combined immunodeficiency, TTP, von Willebrand disease, X. linked agammaglobulinemia, X. linked immunodeficiency, IgM and IgG subclass deficiencies.

The number of diseases being treated with intravenous gammaglobulin immunoglobulins (IV IgG) is increasing.

Side effects include: headaches, chills, chest discomfort, muscle pain and low back pain which are usually minor and occur during drug infusion.

Infusions rarely associated with aseptic meningitis, rash, renal tubular necrosis in patients at risk for kidney disease, thromboembolic problems in patients at high risk for such problems and anaphylaxis in patients with IgA immunoglobulin deficiency.

In patients with selective IgA deficiency or with antibodies to IgA should receive IVIgG with extreme caution.

Mechanism of action of immunomodulatory effect not yet identified.

Suspected that mechanism of action varies according to the disease process and the specific type of immunoglobulin preparation.

Hypotheses for mechanism of action include: blockage of reticular endothelium system via reversible binding of Fc region of IgG into the macrophage FcyR, and causes subversion of natural killer cell sensitivity.

Polyvalent IgG immune globulin may help to prevent or treatinfection in infants, particularly preterm infants with low serum IgG levels.

Prophylactic use of intravenous immune globulins in a review of 19 trials involving more than 5000 preterm below birth weight, inference reduced the rate of late onset infection by 3% with no significant reduction in rates of death and adverse effects (Ohlsson A et al).

Seven trials of adjuvant injured venous immune globulin involving 338 newborn infants of any gestational age with suspected or proven sepsis revealed no difference in mortality (Alexandria MM et al).

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