Immunoglobulin intravenous

The development of freeze-drying for the production of blood derivatives was pioneered during World War II (96,97). It is used for the stabilization of coagulation factor (98,99) and intravenous immunoglobulin (IgG iv) products, and also for the removal of ethanol from intramuscular immunoglobulin (IgG im) solutions prior to their final formulation (Fig. 2). 

The early immunoglobulin products prepared by cold-ethanol fractionation were found to be free from transmitting hepatitis infection (106,108) this was not the case with products prepared by alternative methods (109). Subsequentiy, some batches of intravenous immunoglobulin transmitted hepatitis infection (110), emphasizing the importance of estabHshing vaHdated procedures for dealing with potential viral contaminants (111). 

The resuspended and formulated Fraction II precipitate normally contains some aggregated IgG and trace substances that can cause hypotensive reactions in patients, such as the enzyme prekail ikrein activator (186). These features restrict this type of product to intramuscular adininistration. Further processing is required if products suitable for intravenous adininistration are required. Processes used for this purpose include treatment at pH 4 with the enzyme pepsin [9001-75-6] being added if necessary (131,184), or further purification by ion-exchange chromatography (44). These and other methods have been fiiUy reviewed (45,185,187,188). Intravenous immunoglobulin products are usually suppHed in the freeze-dried state but a product stable in the solution state is also available (189). 

The clinical use of plasma products varies widely between countries (Table 8) with commercial products being imported in some instances to meet demand. In the United States, the market for plasma products increased from 250,000,000 in 1980 to over 850,000,000 in 1991. This expansion resulted from a 60% increase in the use of albumin, a 70% increase in the use of Eactor X concentrate, and the introduction of intravenous immunoglobulin (IgG iv). The 1987 quantity of IgG iv was 10.7 kg per million population by 1991 this usage had increased approximately 220%. The introduction of highly... 

Fig. 6. Share of U.S. market occupied by human albumin/plasma protein fraction, (—) Factor VIII concentrate, (-) intravenous immunoglobulin...

Table 10. Properties of Normal Immunoglobulin and Intravenous Immunoglobulin...

Mononeuropathy multiplex (MM) is an infrequent complication that can occur in early HIV infection, because of dysimmune or vasculitic mechanisms (Gherardi et al. 1989 Chamonard et al. 1993 Bradley and Verma 1996 Schifitto et al. 1997 Mahadevan et al. 2001). Seroconversion-related MM has been described in a case report (Sngimoto et al. 2006). Most of these patients have a good prognosis as symptoms resolve spontaneously and treatment may not be necessary. In others, treatment has focused on intravenous immunoglobulin, judicious short-term use of steroids, and a combination of zidovudine and plasmapheresis (Chamouard et al. 1993 Cohen et al. 1993 Bradley and Verma 1996 Schifitto et al. 1997). 

HDL High-density lipoprotein IVIG Intravenous immunoglobulin... 

Dauvilliers, Y., Carlander, B., Rivier, F., Touchon, J. 8r Tafti, M. (2004). Successful management of cataplexy with intravenous immunoglobulins at narcolepsy onset. Ann. Neurol. 56, 905-8. 

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. 

Bayry J, Thirion M, Misra N, Thorenoor N, Delignat S, Lacroix-Desmazes S et al. Mechanisms of action of intravenous immunoglobulin in autoimmune and inflammatory diseases. Neurol Sci 2003 24 S217-21. 

Perlmutter, S.J., Leitman, S.F., Garvey, M.A., Hamburger, S., Feldman, F., Leonard, H.L., and Swedo, S.F. (1999) Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet 354 1153-1158. 

DelGiudice-Asch, G., Simon, L., Schmeidler, J., Cunningham-Rundles, C., and Hollander, E. (1999) Brief report a pilot open clinical trial of intravenous immunoglobulin in childhood autism. J Autism Dev Disord 29 157-160. 

Reprinted after modifleation from Journal of Allergy and Clinical Immunology, Vol. 111, Binstadt BA, Geha RS, and Bonila FA, IgG Fe reeeptor polymorphisms in human disease Implications for intravenous immunoglobulin therapy, 697-703 (2003) with permission from the American Academy of Allergy, Asthma, and Immunology. 

Binstadt BA, Geha RS, Bonilla FA. IgG Fc receptor polymorphisms in human disease implications for intravenous immunoglobulin therapy. J Allergy Clin Immunol 2003 697-703. 

In four patients with a pure motor demyelinating neuropathy treated with oral prednisolone (60 mg/day) motor function rapidly deteriorated within 4 weeks of starting prednisolone (SEDA-19, 375 54). Intravenous immunoglobulin some months later in two of them produced clear improvement in strength and motor nerve conduction. 

Donaghy M, Mills KR, Boniface SJ, Simmons J, Wright I, Gregson N, Jacobs J. Pure motor demyehnating neuropathy deterioration after steroid treatment and improvement with intravenous immunoglobulin. J Neurol Neurosurg Psychiatry 1994 57(7) 778-83. 

Feuillet L, Guedj E, Laksiri N, Philip E, Habib G, Pelletier J, Cherif AA. Deep vein thrombosis after intravenous immunoglobulins associated with methylprednisolone. Thromb Haemost 2004 92 662-5. 

Diabetes mellitus in a 36-year-old man with acute pancreatitis could not be controlled with continuous subcutaneous insulin infusion, even with doses up to 1800 U/ day, because of insulin resistance (168). Intravenous insulin by pump had to be stopped because of a catheter infection. The continuous subcutaneous infusion of freeze-dried insulin and the addition of aprotinin, a protease inhibitor, soluble dexamethasone or prednisolone, and intravenous immunoglobulin was ineffective. An implantable pump for intraperitoneal delivery established good regulation at a dosage of 30 U/day. 

Blood glucose should be monitored in patients with diabetes mellitus who receive glucose-containing intravenous immunoglobulin (484). 

Stangel M, Hartung HP, Marx P, Gold R. Intravenous immunoglobulin treatment of neurological autoimmune diseases. J Neurol Sci 1998 153(2) 203-14. 

Bayary J, Dasgupta S, Misra N, et al. Intravenous immunoglobulin in autoimmune disorders an insight... 

Hamrock DJ. Adverse events associated with intravenous immunoglobulin therapy. Int Immunopharmacol. 2006 6 535-542. 

Rhoades CJ, Williams MA, Kelsey SM, Newland AC. Monocyte-macrophage system and targets for immunomodulation by intravenous immunoglobulin. Blood Rev. 2000 14 14-30. 

There is no cure for SLE. Guillermo el al. (G16) found only 10 randomized controlled trials during the past 5 years, 5 for lupus nephritis and 5 for all SLE patients. Compared to conventional therapies for lupus nephritis, a monthly bolus with intravenous cyclophosphamide is more effective than a monthly bolus with methyl prednisolone, but has significant side effects (including amenorrhea, cervical dysplasia, avascular necrosis, and herpes zoster) in both groups (G14). In order to avoid these side effects, more recent therapies have been developed. However, neither plasmapheresis (Wl), intravenous immunoglobulin (B21), recombinant human DNase (rhDNase) (D3), nor mycophenolate mofetil (C14) was shown to be more effective than conventional therapy. However, some of these... 

B21. Boletis, J. N., Ioannidis, J. P., Boki, K. A., and Moutsopoulos, H. M., Intravenous immunoglobulin compared with cyclophosphamide for proliferative lupus nephritis. Lancet 354, 569-570... 

Prophylactic intravenous administration of standard immune globulin as compared with cote-lipopolysaccharide immune globulin in patients at high risk of postsurgical infection. The Intravenous Immunoglobulin Collaborative Study Group. N Engl J Med 327 (1992) 234-240. 

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