Immune globulins

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. 

Rh immune globulin for intravenous use may have a place in specific transfusion therapies. 

Discuss the use of vaccines, toxoids, immune globulins, and antivenins to provide immunity against disease. 

Passive immunity is obtained from the administration of immune globulins or antivenins. This type of immunity provides die individual with ready-made antibodies from another human or an animal (see Pig. 54-1). Passive immunity provides immediate immunity to die invading antigen, but lasts for only a short time. The Summary Drug Table Agents for Fhssive Immunity identifies agents for passive immunizations. Display 54-4 provides an example of passive immunity. 

Infants born to HBsAg-positive mothers should receive hepatitis B vaccine and 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites. The second dose is recommended at age 1-2 months and the vaccination series should be completed (third or fourth dose) at age 6 months. 

Rh (D) immune globulin micro-dose (Rh [D] IG) r-h-d-em-une -glob -u-lin Respiratory syncytial virus immune globulin IV (human)... 

An example of passive immunity is the administration of immune globulins (see Summary Drug Table Agents for Passive Immunity), such as hepatitis B immune globulin. Administration of this vaccine is an attempt to prevent hepatitis B after the individual has been exposed to the virus. 

Adverse reactions to immune globulins are rare. However, local tenderness and pain at the injection site may occur. The most common adverse reactions include urticaria, angioedema, erythema, malaise, nausea, diarrhea, headache, chills, and fever. Adverse reactions, if they occur, usually last for several hours. Systemic reactions are extremely rare... 

The immune globulins are contraindicated in patients with a history of allergic reactions after administration of human immunoglobulin preparations and individuals with isolated immunoglobulin A (IgA) deficiency (individuals could have an anaphylactic reaction to subsequent administration of blood products that contain IgA). 

Human immune globulin intravenous (IGIV) products have been associated with renal impairment, acute renal failure, osmotic nephros s and death. Individuals with a predication to acute renal failure, such as those with preexisting renal disease, diabetes mellitus individuals older than 65 years or patients receiving nephrotoxic drugs should not be given human IGIV products... 

The immune globulins and antivenins are administered cautiously during pregnancy (Pregnancy Category C) and lactation and in children. 

Vaccinations containing live organisms are not administered within 3 months of immune globulin administration because antibodies in the globulin preparation may interfere with the immune response to the vaccination. Corticosteroids, antineoplastic dru, and radiation therapy depress the immune system to such a degree that insufficient numbers of antibodies are produced to prevent the disease. When the salicylates are administered with the varicella vaccination, there is an increased risk of Reye s syndrome developing. 

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