Intravenous immunoglobulins


Polyvalent immunoglobulins are used in the treatment of congenital or acquired immunodeficiencies and in the management of some immune disorders.
 
Incidence
2 to 6% (rate related).
 
Risk factors
Selective IgA deficiency.
 
Common variable hypogammaglobulinaemia.
 
Multiple blood or plasma infusions.
 
Clinical manifestations
Occurring one the first or second infusion.
 
Severe: anaphylactic shock.
 
Moderate: chest tightness, mild wheezing.
 
Mild: headache, flushing, low backache, muscle pain, nausea, chills, abdominal pain.
 
Diagnostic methods
IgG anti IgA antibodies are detected in a 22% of patients with common variable immunodeficiency, and in 20 to 60% of patients with selective IgA deficiency.
 
Anti IgA antibodies are found more frequently in patients with combined IgA and IgG2 subclass deficiencies.
 
IgA antibodies are class-specific, subclass-specific, antiallotypic, antiisoallotypic, or of limited specificity.
 
IgE anti IgA (ELISA) have been reported in patients with anaphylactic shock and IgA deficiency.
 
Mechanisms
Formation of immune complexes between antibodies in intravenous immunoglobulins and microbial antigens in the recipient with subsequent complement activation.
 
Presence of IgG or IgE anti IgA in patients with absolute absence of IgA.
 
Management
Prophylactic use of hydrocortisone and an antihistamine is advisable (first and second infusion).
 
Use IgA-depleted intravenous immunoglobulins preparations in patients with high titers of anti IgA antibodies.

References

  1. Misbah SA, Chapel HM, "Adverse effects of intravenous immunoglobulins", Drug. Safety. 1993; 9 (4): 254-62
  2. Burks AW, Sampson HA, Buckley RH, "Anaphylactic reactions after gammaglobulin administration in patients with hypogammaglobulinemia", New Eng. J. Med., 1986; 314 (9): 560–4.
  3. Lederman HM, Roifman CM, Lavi S, Gelfand EW, "Corticosteroids for prevention of adverse reactions to intravenous immune serum globulin infusion in hypogammaglobulinemic patients", Am. J. Med., 1986; 81: 443–6.
  4. Wells JV, King MA, "Adverse reactions to human plasma proteins", Anaesth. Intensive. Care., 1980; 8 (2): 139-44

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.