Diarrhea immunoglobulin

In passive immunotherapy immune globulin (Ig) is an effective replacement in most forms of antibody deficiency (14). In the past, plasma was used instead of immune globulin, but plasma is rarely indicated in the 1990s because of the risk of disease, particularly AIDS, transmission. Because plasma contains many factors in addition to immunoglobulins (Igs), plasma is, however, of particular value in patients with protein-losing enteropathy, complement deficiencies, and refractory diarrhea. 

IMMUNODEFICIENCY WITH HYPER-IGM (HIGMl), AN IMMUNOGLOBULIN ISOTYPE SWITCH DEFECT CHARACTERIZED BY ELEVATED CONCENTRATIONS OF SERUM IGM AND DECREASED AMOUNTS OF ALL OTHER ISOTYPES. AFFECTED MALES PRESENT AT AN EARLY AGE (USUALLY WITHIN THE FIRST YEAR OF LIFE) RECURRENT BACTERIAL AND OPPORTUNISTIC INFECTIONS, INCLUDING PNEUMOCYSTIS CARINII PNEUMONIA AND INTRACTABLE DIARRHEA DUE TO CRYPTOSPORIDIUM INFECTION. DESPITE SUBSTITUTION TREATMENT WITH INTRAVENOUS IMMUNOGLOBULIN, THE OVERALL PROGNOSIS IS RATHER POOR, WITH A DEATH RATE OF ABOUT 10% BEFORE ADOLESCENCE. 

In 1969 the Joint Study Group of the Indian Council of Medical Research—Government of West Bengal— WHO Cholera Research Project investigated the immunoglobulin levels in serum, intestinal juice, and feces from patients with cholera and noncholeraic diarrhea. They reported the following findings ... 

Sarker, S.A., Casswall, T.H., Mahalanabis, D., Alam, N.H., Albert, N.J., Briissow, H., Fuchs, G.J., and Hammarstrom, L. 1998. Successful treatment of rotavirus diarrhea in children with immunoglobulin from immunised bovine colostrum. Pediatr. Infect. Dis. J. 17, 1149-1154. 

The most frequent adverse effects of intravenous immunoglobulin (Sandoz) for the treatment of various disorders (affecting 1-3% of patients in aU) were headache, nausea, vomiting, and fever. Some other mild sjmp-toms have an incidence below 1%, including abdominal pain, diarrhea, fatigue, malaise, dizziness, myalgia, and chest tightness. 

It should be noted that Arabian lymphoma of the small intestine, presenting as intractable diarrhea and malabsorption in teenagers of Arabian stock (though also found in Pakistanis) will be associated with serum IgG and IgM deficiency with an apparently marked increase in IgA. The latter is due, however, to polymerized heavy chains only, i.e., a-chain disease (7.6.5) and should not be confused with the present immunoglobulin pattern. 

The first patient treated with a thymic factor was a 4-year-old girl with thymic hypoplasia and abnormal immunoglobulin synthesis (Wara et al, 1975 Wara, 1983). She was treated with TF5 at a dose of 20 mg/kg/week for a total of 33 months. After 1 month of thymosin therapy, she had conversion of delayed hypersensitivity skin tests as well as an increase in absolute lymphocyte count. In addition, T cell percentages increased from 10 to 60% and serum immunoglobulin levels increased from 220 to 1220 mg/dl. However, no effects were seen on T cell functions in lymphoproliferative responses to T cell mitogens or in MLR. The patient s clinical condition improved with a decrease in the number and severity of infections and diarrhea. She has continued off therapy and appears healthy at age 13. This initial success prompted the many subsequent therapeutic attempts with a variety of thymic preparations. 

Gastrointestinal Nausea [39, 52 ], vomiting, and diarrhea have been associated with intravenous immunoglobulin [39 ]. 

The most commonly reported adverse events are mild local injection reactions, such as erythema, edema, swelling, pruritus, and local heat [48 , 60, 63 ], whose incidence decreases over time [48 ]. The incidence of non-infusion-site reactions after subcutaneous administration (0.24 events per infusion) is similar to the total incidence of 0.25 events per infusion during treatment with intravenous immunoglobulin [48 ]. Non-infusion-site adverse events after subcutaneous administration include headache, diarrhea, fatigue, and nausea [48 "]. 

Gastrointestinal Gastrointestinal adverse events include nausea, vomiting, anorexia, diarrhea, and cramping [I , SS , 54", 55 , 57 ]. Necrotizing enterocolitis after phototherapy and intravenous immunoglobulin for hemolytic disease of the newborn has been reported in three cases [64 ]. 

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