Adverse Effects of Immunoglobulin Therapy

Abstract

Immunoglobulin has been widely used in a variety of diseases, including primary and secondary immunodeficiency diseases, neuromuscular diseases, and Kawasaki disease. Although a large number of clinical trials have demonstrated that immunoglobulin is effective and well tolerated, various adverse effects have been reported. The majority of these events, such as flushing, headache, malaise, fever, chills, fatigue and lethargy, are transient and mild. However, some rare side effects, including renal impairment, thrombosis, arrhythmia, aseptic meningitis, hemolytic anemia, and transfusion-related acute lung injury (TRALI), are serious. These adverse effects are associated with specific immunoglobulin preparations and individual differences. Performing an early assessment of risk factors, infusing at a slow rate, premedicating, and switching from intravenous immunoglobulin (IVIG) to subcutaneous immunoglobulin (SCIG) can minimize these adverse effects. Adverse effects are rarely disabling or fatal, treatment mainly involves supportive measures, and the majority of affected patients have a good prognosis.

Effectiveness of Intravenous Immunoglobulin for Children with Severe COVID-19: A Rapid Review

“…IVIG may increase the risk of infections transmitted by transfusion (42). Some adverse effects, such as thrombosis, aseptic meningitis, hemolysis, and renal failure, are mainly associated with the use of high-dose IVIG (46).…”

Predictive factors of first dosage intravenous immunoglobulin-related adverse effects in children

“…Introduction Intravenous immunoglobulin (IVIG) therapy is widely used in the treatment of primary and secondary immunodeficiency diseases, Kawasaki disease, idiopathic thrombocytopenic purpura, and neurological diseases, such as Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, polymyositis, multiple sclerosis, autoimmune encephalitis, and epilepsy [1,2]. Regardless of age, disease, and severity of adverse effects (AEs), the incidence of IVIGrelated AEs (IVIG-AEs) has been reported to be 0.6% -87.5% [1,[3][4][5][6][7][8][9][10][11][12][13]. The incidences of IVIG-AEs were reported to be lower in children than in adults; however, they still range from less than 1% to 40% [3,12].…”

“…IVIG-AEs are divided into immediate AEs that occur during or within 30 minutes after starting IVIG administration and delayed AEs that occur from 8 hours to 10 days after commencement of IVIG administration [1,3,5,13,14]. In a previous prospective study of IVIG-AEs in pediatric patients, the incidence rates of immediate and delayed AEs were reported to be 10.3% and 41.4%, respectively [3].…”

“…Immediate AEs in adult and pediatric patients show mild flu-like symptoms, such as headache, flushing of the face, malaise, tightness in the chest, fever, chills, myalgia, fatigue, dyspnea, back pain, nausea, and tachycardia [1,3,5,13,14]. In contrast, the symptoms of delayed AEs include severe symptoms, such as acute renal failure, thromboembolic events, neurological toxicity (i.e., aseptic meningitis), hematological toxicity, dermatological toxicity, pseudohyponatremia, arthritis, and pulmonary complications [1,3,5,13,14]. Several previous studies suggested that migraine may be a risk factor for aseptic meningitis associated with IVIG [4,15,16].…”

“…Other studies suggested that IVIG infusion rate, primary infusion of IVIG, history of IVIG-AEs, hydration before and after IVIG infusion, immunoglobulin preparation, underlying diseases (immunoglobulin A deficiency, hypertension, thrombopoiesis, etc. ), and age may be risk factors of IVIG-AEs [1,6,7,13,14,17,18]. However, clinical data regarding predictive risk factors for IVIG-AEs are limited.…”