Immune globulin preparations

Antibodies in the immune globulin preparations may interfere with the immune response to live virus vaccines, particularly measles, but also others, such as mumps and rubella It is recommended that the live virus vaccines be administered 14 to 30 days before or 6 to 12 weeks after administration of immune globulins. No known interactions have been reported with antivenins. 

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). 

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. 

Intravenous Immune Globulin (IGIV) IGIV is a product derived from blood plasma from a donor pool similar to the immune globulin (IG) pool, but prepared so it is suitable for intravenous use. IGIV does not transmit infectious diseases. It is primarily used for replacement therapy in primary antibody-deficiency disorders, for the treatment of Kawasaki disease, immune thrombocytopenic purpura, hypogammaglobulinemia in chronic lymphocytic leukemia, and in some cases of HIV infection. 

Normal immunoglobulins (often termed immune globulins in the USA) represent antibody preparations purified from the plasma, serum or placentas of normal, healthy donors. Blood obtained from such individuals will contain a wide range of antibody specificities. The range of specificities were produced over many years, as the individual s immune system came into contact with various antigens, either naturally (infections) or artificially (by vaccination). 

Three basic approaches are used to control viral diseases vaccination, antiviral chemotherapy, and stimulation of host resistance mechanisms. Vaccination has been used successfully to prevent measles, rubella, mumps, poliomyelitis, yellow fever, smallpox, chickenpox, and hepatitis B. Unfortunately, the usefulness of vaccines appears to be limited when many stereotypes are involved (e.g., rhinoviruses, HIV). Furthermore, vaccines have little or no use once the infection has been established because they cannot prevent the spread of active infections within the host. Passive immunization with human immune globulin, equine antiserum, or antiserum from vaccinated humans can be used to assist the body s own defense mechanisms. Intramuscular preparations of immune globulin may be used to prevent infection following viral exposure and as replacement therapy in individuals with antibody deficiencies. Peak plasma concentrations of intramuscular immune globulins occur in about 2 days. In contrast, intravenously administered immune globulin provides immediate passive immunity. 

Immune globulin, given intramuscularly or intravenously, is recommended in the treatment of primary humoral immunodeficiency, congenital agammaglobulinemias, common variable immunodeficiency, severe combined immunodeficiency, idiopathic thrombocytopenic purpura, and autoimmune hemolytic anemia. There are six licensed preparations of immune globulin. 

Mechanism of Action. Commercial preparations of immune globulin mimic the normal role of endoge-... 

See the following references for an analysis of additional uses of intravenously administered immune globulin Ratko TA et al Recommendations for off-label use of intravenously administered immunoglobulin preparations. JAMA 1995 273 1865 and Dalakas MC Intravenous immune globulin therapy for neurologic diseases. Ann Intern Med 1997 126 721. 

Immune globulin (IG) is a purified preparation of gamma globulin. It is derived from large pools of human plasma and is comprised of four subclasses of antibodies, approximating the distribution of human serum (Ballow, 2005). 

Induction therapy with polyclonal and monoclonal antibodies (mAbs) has been an important component of inunu-nosupression when the beneficial effect of antilymphocyte globulin (ALG) in the prophylaxis of rejection in renal transplant recipients was demonstrated. Over the past 40 years, several polycolonal antilymphocyte preparations have been used in renal transplantation however, only two preparations are currently FDA approved lymphocyte immune globulin (ATGAM) and antithymocyte globulin (Thymoglobulin). 

Two types of products are available for the prevention of hepatitis A immune globulin (IG) and hepatitis A vaccine. IG is a solution of antibodies prepared from human plasma that is made with a serial ethanol precipitation procedure that inactivates HBV and HIV. When administered intramuscularly before exposure to HAV, or within 2 weeks after exposure, IG is >85% effective in preventing hepatitis A. IG administration is recommended for a variety of exposure situations (e.g., for persons who have sexual or household contact with patients who have hepatitis A). The duration of protection is relatively short (i.e., 3-6 months) and dose dependent. 

Indicated and approved for the management of allograft rejection in renal transplant patients, antithymocyte globulin preparations are purified immune globulins (primarily IgG) from horses or rabbits immunized with human thymus lymphocytes. The resultant globulin preparations contain cytotoxic antibodies to human T lymphocytes which function as an immunosuppressive agent. As well as its use for the treatment of renal transplant rejection, anti-thymocyte globulin may be administered as an adjunct to other immunosuppressive... 

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