Intravenous immune globulin (IVIG) preparations are efficacious and safe products in use world-wide. Although rare, side-effects of IVIG may be serious, even life-threatening, and clinicians should be aware of their potential occurrence.
The clinical benefit of immune globulin prophylaxis in patients
with primary antibody deficiency syndromes has been clearly
established. In the past, replacement therapy was provided
through intramuscular injections. In the early 1980s, highly
purified monomeric suspensions of IgG for intravenous use
became available and more than 10 commercial preparations
of intravenous immune globulin (IVIG) are now at the disposal
of the clinician. The indications for administration of
IVIG have been enlarged to include transitory primary antibody
deficiencies (such as low birth-weight premature babies),
secondary hypogammaglobulinaemic states [as in chronic
lymphatic leukaemia (CLL) or multiple myeloma], and conditions
with increased susceptibility to infections (such as bone
marrow transplant.or the post-surgery period). In addition to
its efficacy as replacement therapy, IVIG now has wellestablished
therapeutic applications in some haematological
and autoimmune diseases: IVIG preparations are used successfully
in immune thrombocytopenic purpura (ITP), in Kawasaki
disease, and for some desperate diseases for which there is no
other efficient treatment [reviewed in refs 1 and 2]. The mechanisms
of action of IVIG in these conditions, although not yet
fully determined, include a reticulo-endothelial blockade, an
immunomodulatory effect (by supplying anti-idiotype antibodies),
and an anti-inflammatory action.
This growing usage has increased the need for high quality
immune globulin products and, indeed, high-dose IVIG can be
administered with only mild, self-limited side-effects. This
paper reviews the most frequent adverse reactions reported
with IVIG therapy from the time of its introduction into the
clinic. Possible underlying causes of these reactions and their
current management are described briefly.
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