Infusion reactions intravenous immunoglobulin

Observational studies In an observational study in 51 patients with primary immunodeficiencies with 642 infusions, drug-related adverse reactions occurred during six infusions in four patients none was serious [51 ]. In another study in 46 patients with primary immunodeficiency, 20% of the 601 infusions were associated with treatment-related adverse events, none of which was serious. Of the treatment-related adverse events, 59% were categorized as mild, 36% as moderate, and 5% as severe most were transient [44. In a safety study in 208 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), 113 patients were exposed to 1096 infusions of intravenous immunoglobulin 55% had drug-related adverse events, an adverse event rate of 18 per 100 infusions, with five serious adverse reactions during the 1-year study [45. ... 

Subcutaneous administration of immunoglobulins may have several advantages. Compared with intravenous immunoglobulin, the trough IgG concentrations obtained are more stable and more physiological Furthermore, subcutaneous administration is associated with fewer systemic adverse reactions than intravenous administration [63 ] and it benefits patients with poor venous access [48 , 62 ]. Moreover, the extreme IgG peaks after infusion of intravenous immunoglobulin that are... 

Some reports suggest that anaphylaxis due to intravenous immunoglobulin infusion occurs most often in patients with primary hypogammaglobulinemia (115,116). However, anaphylactic reactions have been seen in two atopic patients with idiopathic thrombocytopenic purpura, and the authors warned that children with atopic disease should not receive intravenous immunoglobulin (117). 

Leclech C, MaiUard H, Penisson-Besnier I, Laine-Cessac P, Verret JL. Reaction cntanee inhabituelle apres perfusion intraveineuse d immunoglobulines polyvalentes. [Unusual skin reaction after intravenous infusion of polyvalent immunoglobulins 3 case reports.] Presse Med 1999 28(10) 531. 

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 "]. 

Intravenous immunoglobulin products differ in excipients and physicochemical characteristics. Each may have slightly different profiles of efficacy and adverse reactions. The reported adverse reaction rate varies between 2% and 25% of all infusions, depending on the disease being treated and the patient population. There is a higher incidence rate after a first exposure. Most of the adverse reactions are classified as being of mild-to-moderate intensity [1 , 54, 57", 58"]. In one prospective study in almost 400 patients with immunodeficiency (over 13 000 infusions), the adverse reaction rate was 0.8% none of these events was classified as severe [54 ]. In 38 children there was an adverse reaction rate of 9% of all infusions none was life-threatening [59"]. In 70 patients who received 1085 infusions there was an adverse events rate of 4.3% of all infusions (33% of all patients) none was serious [58"]. In one study of 341 infusions, severe adverse reactions led to discontinuation of therapy in 4% of all treatment courses [53 ]. 

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