Immune globulin
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Immune globulin Various toxicities: 13 case reports
In a prospective study measuring adverse reactions to immune globulin, 13 patients [sexes not stated] aged 13 to 67 years experienced various toxicities while receiving immune globulin for common variable immunodeficiency. The patients received premedication with corticosteroids and antihistamines. A median of 36 months after initiating IV immune globulin (IVIG) [dosage not stated], they experienced severe adverse reactions [see table]. In patients 4 and 7, the reactions had occurred from the beginning of treatment; the rest of the patients had tolerated immune globulin well for 12–288 months. Different preparations of IVIG were tried, but were unsuccessful in preventing adverse reactions.
Clinical Characteristics Patient no./age (years)
Months of IVIG therapy
Adverse reactions after IVIG
1 / 49
288
Hypotension, angioedema
5
2 / 35
36
12
3 / 45
84
Hypotension, chills, nausea, fever Hypotension, chills fever
4 / 33
4
6
5 / 36
72
6 / 13
132
7 / 23
2
8 / 67
22
Back pain, headache, chills, fever Hypertension, headache, chills, fever Hypotension, chills, cyanosis, fever Hypotension, chills, angioedema Hypotension, chills, fever
9 / 44
48
Angioedema
10
10 / 47
12
Angioedema, mucositis
2
11 / 61
32
2
12 / 46
86
Hypotension, fever, angioedema Hypotension, chills, fever
13 / 37
24
Chills, fever, nausea, vomiting
120
1
the drug twice per week. After 9 months of treatment, patient 4 experienced hypotension, chills, fever, back pain and headache. The SCIG dosage was reduced to 1.6 mg per week, and treatment continued without further problems. The dose was subsequently increased back to 400 mg/kg per month, and was tolerated well. Patient 7 experienced hypotension and angioedema at the first administration of Vivaglobin [time to reaction onset not stated], and SCIG was withdrawn. One month later, the patient started treatment with Subcuvia with no further problems. To date, all patients had received SCIG treatment for at least 12 months, without severe side effects except for patients 4 and 7. Author comment: "From this study, we may conclude that a severe [adverse reaction] to both IVIG and SCIG is a rare but unpredictable event." Quinti I, et al. Prospective study on CVID patients with adverse reactions to intravenous or subcutaneous IgG administration. Journal of Clinical Immunology 801111626 28: 263-267, No. 3, May 2008 - Italy
Duration Adverse of IVIG reactions withdrawal after SCIG (months)
6
2
2
94
12
2
Local oedema, redness Local oedema, redness Local oedema, redness Hypotension, chills, fever Local oedema, redness Local oedema. redness Hypotension, angioedema Local oedema, redness Local oedema, redness Local oedema, redness Local oedema, redness Local oedema, redness Local oedema, redness
In all 13 patients IVIG was withdrawn slowly over 2–120 months. The patients were then treated with antibacterial prophylaxis for a mean of 21 months. During this time, IgG levels dropped in all patients. Patients 4, 6 and 13 rec
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