Adverse Reactions to Intravenous Immunoglobulins - Our Experience

Abstract

BACKGROUND:Adverse reactions to intravenous immunoglobulins (IVIG) are divided by organ system involved, or by timing of onset–immediate which occur during infusion usually rate-related, true IgE-mediated anaphylaxis and delayed reaction which occur hours to days after the infusion.AIM:To describe the adverse events of patients given IVIG infusions.METHODS:Total number of patients receiving IVIG was 41 with 25 males (60.97%) and 16 females (39.02%), age 2 months-35 years. A total number of infusions was 1350.RESULTS:Total number of adverse reactions 15, 14 patients with immediate-type and 1 with delayed type. Total percentage of adverse reactions in a given sample was 1.1% of all IVIG infusions. Fever was the most common immediate type of reaction occurring in 11 patients (78.57%) followed by acrocyanosis 10 patients (71.42%), skin rash 9 patients (64.28%) and headache 8 patients (57.14). Delayed-type of reactions (like fever, headache and vomiting) was present in one patient. Majority of the adverse effects occurred at the infusion rate higher than 1, 5 ml/kg/hour, which is still within recommended speed.CONCLUSION:About 1.1% of IVG infusions where with adverse events. Most common manifestations where: fever, acrocyanosis, skin rash and headache, which occurred 1-6 hours from the beginning of the infusion. The occurrence of adverse reactions to IVIG was related to the infusion rates in a fashion that faster infusion rate gives more reactions. Adverse reactions were managed by reduction of the infusion rate and administration of medications such as paracetamol, antihistamines and steroids.

Quality of Life Evaluation in Saudi Arabian Pediatric Patients with Primary Immunodeficiency Diseases Receiving Subcutaneous IgG Infusions at Home

“…However, this meta-analysis had signi cant statistical heterogeneity and included two older studies (studies weight > 50%) [6]. Patients tolerability to IVIG has improved in last decades, with a major determinant are the IgA content, sodium content, sugar content and osmolality for some IVIG preparation [19]. Only two patients in this study switched to SCIG because of previous systemic side effect to IVIG.…”

Achromobacter xylosoxidans/denitrificans Bacteremia in a Patient With Good’s Syndrome

“…However, a true IgE mediated anaphylaxis is possible especially in an IgA-deficient patient, which is in our case. A careful selection of IG preparations and pre-medications with antihistamines, acetaminophen, and corticosteroid were critical in further treatment of this patient [ 15 ]. Thus, patients with Good’s syndrome must have appropriate follow-up arranged with an immunologist after the acute infection is appropriately treated for necessary immunological interventions, including immunoglobulin infusion and a proper immunization plan that excludes the use of live vaccines.…”

Intravenous Immunoglobulin-Induced Aseptic Meningitis—A Narrative Review of the Diagnostic Process, Pathogenesis, Preventative Measures and Treatment

“…The infusion should not be faster than 6 g/h and at a dilution of 3%. Kareva et al suggest that the infusion rate is directly proportional to the severity of adverse events [66]. Although slow infusion rate and lower initial dosage of IVIGs [67] are known detrimental factors of adverse reaction prevention caused by IVIG therapy, they do not seem to always exclude their incidence [9].…”