Subcutaneous immunoglobulin therapy given by subcutaneous rapid push vs infusion pump: a retrospective analysis

Shapiro, Ralph

doi:10.1016/j.anai.2013.04.015

Cited by 33 publications

(40 citation statements)

References 20 publications

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“…Otherwise, the permanent production of immune complexes due to continuous treatment with IgG preparations containing IgA molecules would result in immune complex diseases, such as vasculitis. Similar to a previous finding [16], none of our patients has developed symptoms or abnormal laboratory findings that could be related to any systemic affliction. Based on this observation, the impact of treatment with high-dose IgG appears to simultaneously result from the inhibition of circulating anti-IgA and IgA production [9,18].…”

Section: Discussionsupporting

confidence: 75%

“…The fairly large volume is in practice irrelevant. This view is supported by a previous large medical record review demonstrating that the s.c. rapid push can be performed safely and quickly with a high degree of acceptance [16]. Based on our experience, the infusion can be placed on the lateral abdomen, and diffusion can be accelerated using hand massage.…”

Section: Discussionmentioning

confidence: 99%

“…Roughly all available IVIgG preparations are IgA-depleted [13,14], and several preparations are available for s.c. use to minimize adverse reactions [15,16]. …”

Section: Discussionmentioning

confidence: 99%

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Long-Term Treatment and Transfusion of Normal Blood Components Following Tolerance Induction in Patients with Anti-IgA Anaphylactic Reactions

Salama

Kardashi

Arbach

2014

Transfus Med Hemother

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Background: In general, patients with significant anti-Ig-A do not tolerate intravenous (i.v.) administration of normal blood products. Here, we present our experiences in the induction of immune tolerance (IIT) and long-term treatment in a series of such patients affected in such a way. The question whether blood components from IgA-deficient donors are required will be discussed. Methods: Ten adult patients (4 females and 6 males; age ranging from 36 to 75 years) with anti-IgA were included in this study. All patients required long-term treatment with blood components. One patient had IgA deficiency and paroxysmal nocturnal hemoglobinuria (PNH), and all other patients had common variable immunodeficiency (CVID). The particle gel immunoassay was used for the detection of anti-IgA. Immune tolerance to IgA was induced by controlled subcutaneous (s.c.) and/or i.v. infusions of IgG preparations. Results: Prior to IIT, anti-IgA was detectable in plasma samples of all patients and significantly diminished or abolished by controlled s.c. and/or i.v. infusions of IgG. Multiple transfusions with normal blood components could be repeatedly performed with the patient suffering from PNH without any complications. As long as i.v. IgG (IVIgG) infusions were consequently administered as individually required (intervals 2-8 weeks), none of the patients developed reactions during observation (up to 10 years). However, interruption of treatment and re-exposure to IVIgG resulted in adverse reactions. Conclusion: Patients with significant anti-IgA can be safely desensitized and tolerate long-term IgG substitutions independent of the IgA concentration of the used blood component.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Long-Term Treatment and Transfusion of Normal Blood Components Following Tolerance Induction in Patients with Anti-IgA Anaphylactic Reactions

Salama

Kardashi

Arbach

2014

Transfus Med Hemother

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“…67 In case of more frequent administration by push, doses can be daily, twice or three times per week, or even weekly, with adequate safety and a shorter administration time when compared with pumps. 67,134,135 Administration requires 1 to 10mL syringes with 25 to 23 gauge wing sets, 4 to 6mm needles for children and 9 to 15mm needles for adults, 108,132,136 or special perpendicular needles, 26,137 at a rate of 1ml/minute. 35 The total volume applied per site depends largely on the individual tolerability and also varies according to the product, dose and administration time.…”

Section: Mode Of Use (Administration Routes Doses and Intervals)mentioning

confidence: 99%

II Brazilian Consensus on the use of human immunoglobulin in patients with primary immunodeficiencies

Goudouris

Silva

Ouricuri

et al. 2017

Einstein (São Paulo)

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In the last few years, new primary immunodeficiencies and genetic defects have been described. Recently, immunoglobulin products with improved compositions and for subcutaneous use have become available in Brazil. In order to guide physicians on the use of human immunoglobulin to treat primary immunodeficiencies, based on a narrative literature review and their professional experience, the members of the Primary Immunodeficiency Group of the Brazilian Society of Allergy and Immunology prepared an updated document of the 1st Brazilian Consensus, published in 2010. The document presents new knowledge about the indications and efficacy of immunoglobulin therapy in primary immunodeficiencies, relevant production-related aspects, mode of use (routes of administration, pharmacokinetics, doses and intervals), adverse events (major, prevention, treatment and reporting), patient monitoring, presentations available and how to have access to this therapeutic resource in Brazil.

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“…Subcutaneous IgG is a safe, efficient and feasible treatment method especially in infants in whom it is difficult to obtain a vascular access, in patients who have had severe allergic side effects with IVIG and in patients with primary immune deficiencies in association with protein losing enteropathy (17). Other than these, SCIG is also administered because of the following factors: living in a place far from hospital, feeling severe malaise before the next IVIG dose, intense work or school life, frequent travelling and personal preference (17). In our clinic, SCIG was administered most commonly because of personal preference, problematic vascular access, gastrointestinal IgG loss and side effects with IVIG.…”

Section: Discussionmentioning

confidence: 99%

Use of subcutaneous immunoglobulin in primary immune deficiencies

et al. 2016

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Aim: Immunoglobulin replacement therapy is required to reduce the frequency and severity of infections in patients with primary antibody deficiencies. Immunoglobulin G (IgG) can be administered intramuscularly, intravenously or subcutaneously. We aimed to evaluate the efficacy, dose adjustment and adverse events in subcutaneous immunoglobulin therapy by retrospectively presenting the records of 16 patients who received subcutaneous immunoglobulin therapy. Material and Methods: The demographic findings, clinical and laboratory findings, subcutaneous immunoglobulin dosage and dose frequency, infusion time, area and methods, adverse events and frequency of infections were obtained from patient files and recorded. Results: Sixteen patients (seven female, nine male) aged between 0-33 years who were diagnosed with primary immune deficiency and treated with subcutaneous immunoglobulin were enrolled. All patients had been receiving intravenous imunoglobulin (5-10%) at a dose of 0.33-1.25 gr/ kg/dose with two-four week intervals before subcutaneous immunoglobulin. Subcutaneous immunoglobulin (10%) was administered at a dose of 0.03-0.43 gr/kg/dose with one-two week intervals. No significant difference was found between serum through IgG levels before administration of intravenous imunoglobulin and steady state IgG levels during subcutaneous immunoglobulin therapy. When five patients whose serum through IgG levels were below 600 mg/dL were evaluated, however, a significant increase was found in steady state IgG levels with subcutaneous immunoglobulin therapy (p=0.043). In a ten-month follow-up period, seven infections were observed in four patients (three upper respiratory infectons, two lower respiratory tract infections and three acute gastroenteritis). No acute severe bacterial infection was observed. Local advers reaction was reported in only 10 of 180 infusions (6%). No serious adverse events were reported. All 16 patients were willing to continue IgG replacement therapy by subcutaneous administration. Conclusions: Ig replacement therapy by subcutaneous route is an efficient, safe and easy option which is eligible for individual administration. Home therapy is feasible for patients with primary immune deficiency, if informed consent is obtained and sufficient education is ensured. (Turk Pediatri Ars 2016; 51: 8-14)

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Subcutaneous immunoglobulin therapy given by subcutaneous rapid push vs infusion pump: a retrospective analysis

Cited by 33 publications

References 20 publications

Long-Term Treatment and Transfusion of Normal Blood Components Following Tolerance Induction in Patients with Anti-IgA Anaphylactic Reactions

Long-Term Treatment and Transfusion of Normal Blood Components Following Tolerance Induction in Patients with Anti-IgA Anaphylactic Reactions

II Brazilian Consensus on the use of human immunoglobulin in patients with primary immunodeficiencies

Use of subcutaneous immunoglobulin in primary immune deficiencies

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