Intravenous Immunoglobulin: Adverse Effects and Safe Administration

Abstract

Intravenous immunoglobulin (IVIg) is administered for various indications and generally considered a safe therapy. Most of the adverse effects (AEs) associated with IVIg administration are mild and transient. The immediate AEs include headache, flushing, malaise, chest tightness, fever, chills, myalgia, fatigue, dyspnea, back pain, nausea, vomiting, diarrhea, blood pressure changes, tachycardia, and anaphylactic reactions, especially in IgA-deficient patients. Late AEs are rare and include acute renal failure, thromboembolic events, aseptic meningitis, neutropenia, and autoimmune hemolytic anemia, skin reactions, and rare events of arthritis. Pseudohyponatremia following IVIg is important to be recognized. Renal failure, usually oliguric and transient, occurs mostly on using sucrose-containing products owing to osmotic injury. Among high-risk patients who have a previous renal disease, dehydration, diabetes mellitus, advanced age, hypertension, hyperviscosity, or are treated by other nephrotoxic medications, administration of a non-sucrose-containing IVIg product after accomplishing hydration, in a low concentration and a slow infusion rate while supervising urine output and kidney function, is recommended. Thromboembolic complications occur because of hyperviscosity especially in patients having risk factors including advanced age, previous thromboembolic diseases, being bedridden, diabetes mellitus, hypertension, dyslipidemia, or those receiving high-dose IVIg in a rapid infusion rate. Immediate AEs can be treated by the slowing or temporary discontinuation of the infusion and symptomatic therapy with analgesics, nonsteroidal anti-inflammatory drugs, antihistamines, and glucocorticoids in more severe reactions. Slow infusion rate of low concentration of IVIg products and hydration, especially in high-risk patients, may prevent renal failure, thromboembolic events, and aseptic meningitis.

Safety of treatments for primary Sjögren’s syndrome

“…[121] Possible severe side effects of IVIG treatment include renal failure, tromboembolic events, and aseptic meningitis, which may be prevented by a slow infusion rate and prehydration. [122] A retrospective study in 19 pSS patients with peripheral neuropathy reported a beneficial effect of monthly courses of IVIG on SS-associated sensorimotor neuropathy and non-ataxic sensory neuropathy. [123] Tolerance of IVIG was good.…”

Clinical applications of immunoglobulin in neuromuscular diseases: focus on inflammatory myopathies

“…There is also the description of earlyonset severe anaphylaxis commonly associated with IgA deficiency in serum levels lesser than 0.05 g/L. Acute renal failure (not related to sorbitol-based formulations), sepsis, transient neutropenia, disseminated intravascular coagulation, hepatitis C viral and parvovirus B19 infection, Transfusion-associated Acute Lung Injury (TRALI), aseptic meningitis, thrombotic events (deep venous thrombosis, pulmonary embolism, acute myocardial infarction, stroke), pseudohyponatremia and late-onset arthritis, aseptic meningitis and neurodegeneration have also been described in related to the use of IVIg 2,4 . Although initially applied for patients with specific primary immunodeficiency diseases, IVIg is widely used nowadays for different groups of clinical conditions (Table 1), mainly hematological, dermatological and autoimmune diseases 5,6,7,8,9 .…”

BK Nephropathy in Renal Transplant Patients: Review

“…İlaç değişikliğinden 4-10 hafta sonra istenilen hedefe ulaşılır. 18,72,73 Buna rağmen viremi devam ederse mTOR inhibitörü (hedef kan düzeyi 6-8 ng/mL) değişikliği, düşük doz steroid (2,5 mg/gün prednizolon) ve leflunomid gibi yardımcı tedaviler önerilir (Tablo 4). …”