Adverse Effects of Intravenous Immunoglobulin

Abstract

The range of diseases in which intravenous immunoglobulin (IVIG) is effective has expanded significantly since its initial use in primary antibody deficiency. There are at present at least 17 preparations of IVIG in use worldwide with similar profiles of adverse effects. Infusion-related effects range in severity. Mild adverse reactions (headache, flushing, low backache, nausea, wheezing) are often associated with a fast infusion rate, and respond rapidly on slowing the infusion. Very rare episodes of life-threatening anaphylaxis may occur, particularly in those IgA-deficient patients with anti-IgA antibodies; such patients should receive an IgA-depleted preparation of IVIG. There are concerns with any blood product about safety in regard to viral transmission. The 4 outbreaks of non-A non-B hepatitis (probably hepatitis C) in the 1980s were associated with the use of particular batches of IVIG. The more recent exclusion of all anti-hepatitis C virus positive individuals from the donor pool, and the introduction of specific antiviral steps in the manufacture of IVIGs, should prevent further outbreaks. The human immunodeficiency virus (HIV) is effectively inactivated during the manufacturing process itself and HIV transmission has not been reported with IVIG. Rarely, haematological (Coombs' test positive haemolysis), neurological (aseptic meningitis) or renal (transient rises in serum creatinine) adverse effects may be seen when high doses of IVIG are used for immunomodulatory purposes. Haemolysis, due to passive transmission of blood group antibodies (anti-A, anti-D), may be prevented by selecting IVIG batches that give a negative cross-match between the recipient's red cells and IVIG.(ABSTRACT TRUNCATED AT 250 WORDS)

A Case of Skin Necrosis after Extravasation of Intravenous Immunoglobulin

“…Immunoglobulin is prescribed in diverse diseases such as autoimmune diseases like idiopathic thrombocytopenic purpura, primary immunodeficiency disease, and Kawasaki disease [5,21,22]. Common side effects of immunoglobulin treatment are transient light inflammatory responses, including headaches, chills, flushness, back pain, nausea [6,7]. However, severe systematic responses including hemolysis, neutropenia, aseptic meningitis, anaphylactic reaction, thromboembolic diseases can also happen in 2~6% [5,6].…”

“…Common side effects of immunoglobulin treatment are transient light inflammatory responses, including headaches, chills, flushness, back pain, nausea [6,7]. However, severe systematic responses including hemolysis, neutropenia, aseptic meningitis, anaphylactic reaction, thromboembolic diseases can also happen in 2~6% [5,6]. Hyperosmolar immunoglobulin containing sucrose as a base rarely causes renal failure and aseptic meningitis has a relationship with a past history of migraines [22].…”

“…However, it has transient side effects, such as fever, headache, myalgia, back pain, chill, nausea, flush, rash and et cetera. More severe side effects rarely happen, such as hemolysis, neutropenia, aseptic meningitis, anaphylactic reaction, thromboembolism and et cetera [5][6][7]. Skin side effects reported after using IVIG are reported such as eczema, alopecia, erythema multiforme, lichenoid dermatitis, pompholyx [8,9].…”

Immunoglobulin therapy

“…6 A number of patients who received a contaminated batch of hepatitis C antibody screened intravenous immunoglobulin in 1993-94 developed serious hepatitis C-related complications. 7 Modelbased estimates of blood transfusion in 2000-01, following the introduction of nucleic acid technology screening of blood donors, indicated a per unit risk of 1 in 1,600,000 for HCV transmission.…”

Indications for intra-venous immunoglobulin treatment in rheumatic diseases

“…La maggior parte di queste reazioni può risolversi con la temporanea interruzione dell'infusione o con la riduzione della sua velocità ovvero può essere prevenuta con la somministrazione di ASA, paracetamolo o antistaminici prima del trattamento e/o di idrocortisone in concomitanza dello stesso (56). Un importante effetto indesiderato è rappresentato dalla meningite asettica (circa 11% dei pazienti) caratterizzata da cefalea severa, di più frequente osservazione nei soggetti con una anamnesi positiva per crisi emicraniche.…”