The use of intravenous immunoglobulin (IVIG) treatments has increased significantly since this type of therapy was initially developed in the 1950’s. The initial use of human plasma for treatment of autoimmune diseases and other conditions which are difficult to diagnose, came about from the isolation of antigens which can bind with receptors to offer relief from the chronic conditions. Although beginning efforts were entirely composed of pooled plasma treatments from donors, current infusions are more widely synthesized.
In recent years, IVIG treatments have become more refined, with the use of sorbitol instead of sugars to increase the action of the treatment and to reduce side effects that can come from blood sugar imbalances. Donor plasma is still utilized for treatments, although the isolation of autoantibodies has allowed for a greater application of IVIG. This has also increased the number of conditions in which IVIG may be a primary or ancillary form of treatment.
Who Needs IVIG Therapy?
With further advances in the isolation of antibodies within the plasma, IVIG therapy may be utilized for a number of conditions.
FDA approval for IVIG therapy includes:
- Chronic inflammatory demyelinating polyneuropathy
- Immune thrombocytopenic purpura
- Primary immunodeficiency conditions
- Secondary immunodeficiency in chronic lymphocytic leukemia
- Pediatric human immunodeficiency virus (HIV) infection
- Kawasaki disease
- Prevention of graft disease or rejection in transplants
While this does represent the majority of scenarios for IVIG treatments, there are other conditions for which this intervention is utilized. These include the following:
- Dermatological diseases – including conditions such as dermatomyositis, pemphigus, and autoimmune blistering dermatoses
- Neurological conditions – which can include Guillain-Barré syndrome, myasthenia gravis, and multiple sclerosis
- Rheumatic illnesses – these are chronic conditions such as rheumatoid arthritis, systemic lupus erythematosus, polymyositis, and Wegeners granulomatosis
- Blood diseases – this can include aplastic anemia, pure red cell aplasia, autoimmune hemolytic anemia, and blood disease in newborns
- Respiratory illnesses – this includes asthma and lower respiratory tract infections
- Infectious diseases – which may include HIV, organ transplant complications, and complications arising from extensive burns
IVIG Safety and Side Effects
Although this type of treatment is derived from donor plasma, the therapy is considered to be very safe. Precautions are taken to ensure that IVIG treatments are not contaminated with outside contagions, and the process of manufacture isolates antibodies and other proteins to further promote the safety of IVIG.
While IVIG is used for a variety of conditions, there are also a number of formulations that are specific to these different illnesses. This can cause some range in the side effects that may be experienced, although the following symptoms are the most common of complaints:
- Stiffness in the neck and lower back
Most patients state that these symptoms are mild to moderate, and that the use of NSAIDS and even corticosteroids can reduce the effects. Some doctors may also recommend that patients receive a pre-treatment with anti-histamines or NSAIDS in order to reduce the occurrence of side effects.
Since IVIG is not a single formulation, patients can find that one manufacturer’s product produces less side effects than another. This will often be due to different additives to the infusion that may boost the impact that the treatment has on patients, but it can also lead to adverse reactions. Consulting with a doctor or pharmacist regarding the best formulation will also uncover if there are any additives that should be avoided. This will most frequently include:
The overall antibody content of different formulations will also vary and can cause reactions, although these differences in therapy are more likely related to the condition which is being addressed.
Risks and Dangers with IVIG
Some patients may not be able to undergo IVIG therapy, even if they have a condition which may indicate necessity. This can be an allergic reaction that is specific to certain immunoglobulin deficiencies. Warning signs that may indicate a possible danger include:
- High fevers – this can indicate the presence of a severe infection
- Chest pains – this may be accompanied by trouble breathing and can indicate possible damage to the heart and lungs
- Dark urine – this can indicate damage to the kidney or liver, and can be especially serious if it is accompanied by yellowing to the skin and whites of the eyes
- Pain and swelling in the extremities – these could indicate the presence of a blood clot
- Hives – extreme rashes, especially when they are experienced with itching and trouble breathing could indicate a severe allergic reaction
It is important that patients report any of the above problems to a physician as soon as possible, since these are warning signs for grave problems. Allowing these symptoms to persist could result in permanent damage, such as kidney failure, liver disease, or complications from a possible blood clot. Severe reactions are often a result of physiological differences that create a selective antibody situation within the body.
What is the Process for IVIG Therapy?
Since this type of therapy does replace missing antibodies within the bloodstream, there can generally be a loading phase before patients begin to experience results. As the missing antibodies are replaces, the body will begin to balance and respond naturally to internal conditions. This can vastly reduce auto-immune reaction and inflammation, by directing the body to respond normally to the perceived threat.
IVIG can be self administered, or it can be directed by an out-patient or in home care nurse. The treatment was initially done as an intramuscular injection, although the effects of the treatment were found to have a greater impact when administered as an infusion.
Patients are outfitted with an IV bag that contains sterile saline or Ringer’s solution as well as the prescribed dosage of immunoglobulin. Drips will generally take between 2 to 4 hours to complete for one session, and patients are required to continue therapy once they have begun. IVIG is administered every 3 to 4 weeks, and protocols must be kept up with in order to maintain wellbeing.