Skip to main content


Log in

Patients' Attitude to Subcutaneous Immunoglobulin Substitution as Home Therapy

  • Published:
Journal of Clinical Immunology Aims and scope Submit manuscript

Introduction. Since 2003, immunoglobulin preparations have been approved for subcutaneous (s.c.) use in Germany. Although all our adult patients on intravenous (i.v.) substitution were offered to switch to s.c. home therapy, approximately half of them refused to change. Methods. To evaluate patients' attitude towards s.c. home therapy, a questionnaire was developed and sent to 125 patients. Questions had to be answered by ticking numbers on a Likert scale from 1 (not at all) to 8 (very much). Four scales of the Freiburg Personality Inventory (FPI) were added. From the 70 questionnaires returned (56%), 61 could be analysed (i.v. n = 28, s.c. n = 33). Results. The i.v. treated patients were afraid of being more busy with self-administration (6.9 ± 2.1). This was not a serious concern in the s.c. treated group (3.6 ± 1.8, p < 0.001). Many i.v. treated patients worried about severe adverse reactions at home (4.7 ± 2.8), but patients in the s.c. group did not (1.7 ± 1.0, p < 0.001). The statement “I dislike to puncture myself” reached 5.3 ± 2.7 points in the i.v. treated group, but only 2.0 ± 1.1 (p < 0.001) in the s.c. treated patients. As main reason, patients on i.v. substitution considered s.c. therapy as inconvenient (48%). Secondly, they were afraid of side effects (31%). All patients on s.c. therapy appreciated the new treatment (7.2 ± 1.0). Main advantage for them was an increase of flexibility (6.6 ± 1.6). The FPI displayed lower values for s.c. treated patients in the scales “Physical Complaints” and “Emotional Lability”. Conclusion. Those patients who had changed to s.c. therapy were highly satisfied. However, others preferred to stay on i.v. treatment for different reasons. Perception of inconvenience, anxiety of side effects, but also personal traits may play a role.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1.
Fig. 2.

Similar content being viewed by others







Freiburg Personality Inventory


  1. Roifman CM, Levison H, Gelfand EW: High-dose versus low-dose intravenous immunoglobulin in hypogammaglobulinaemia and chronic lung disease. Lancet 1:1075–1077, 1987

    Article  PubMed  CAS  Google Scholar 

  2. Chapel HM, Spickett GP, Ericson D, Engl W, Eibl MM, Bjorkander J: The comparison of the efficacy and safety of intravenous versus subcutaneous immunoglobulin replacement therapy. J Clin Immunol 20:94–100, 2000

    Article  PubMed  CAS  Google Scholar 

  3. Gardulf A, Bjorvell H, Gustafson R, Hammarstrom L, Smith CI: The life situations of patients with primary antibody deficiency untreated or treated with subcutaneous gammaglobulin infusions. Clin Exp Immunol 92:200–204, 1993

    Article  PubMed  CAS  Google Scholar 

  4. Gardulf A, Bjorvell H, Andersen V, Bjorkander J, Ericson D, Froland SS, Gustafson R, Hammarstrom L, Nystrom T, Soeberg B: Lifelong treatment with gammaglobulin for primary antibody deficiencies: The patients' experiences of subcutaneous self-infusions and home therapy. J Adv Nurs 21:917–927, 1995

    Article  PubMed  CAS  Google Scholar 

  5. Gardulf A, Nicolay U, Math D, Asensio O, Bernatowska E, Bock A, Costa-Carvalho BT, Granert C, Haag S, Hernandez D, Kiessling P, Kus J, Matamoros N, Niehues T, Schmidt S, Schulze I, Borte M: Children and adults with primary antibody deficiencies gain quality of life by subcutaneous IgG self-infusions at home. J Allergy Clin Immunol 114:936–942, 2004

    Article  PubMed  CAS  Google Scholar 

  6. Nicolay U, Haag S, Eichmann F, Herget S, Spruck D, Gardulf A: Measuring treatment satisfaction in patients with primary immunodeficiency diseases receiving lifelong immunoglobulin replacement therapy. Qual Life Res 14:1683–1691, 2005

    Article  PubMed  CAS  Google Scholar 

  7. Nicolay U, Kiessling P, Berger M, Gupta S, Yel L, Roifman CM, Gardulf A, Eichmann F, Haag S, Massion C, Ochs HD: Health-related quality of life and treatment satisfaction in north american patients with primary immunedeficiency diseases receiving subcutaneous IgG self-infusions at home. J Clin Immunol 26:65–72, 2006

    Article  PubMed  CAS  Google Scholar 

  8. Gardulf A, Andersen V, Bjorkander J, Ericson D, Froland SS, Gustafson R, Hammarstrom L, Jacobsen MB, Jonsson E, Moller G: Subcutaneous immunoglobulin replacement in patients with primary antibody deficiencies: Safety and costs. Lancet 345:365–369, 1995

    Article  PubMed  CAS  Google Scholar 

  9. Hogy B, Keinecke HO, Borte M: Pharmacoeconomic evaluation of immunoglobulin treatment in patients with antibody deficiencies from the perspective of the German statutory health insurance. Eur J Health Econ 6:24–29, 2005

    Article  PubMed  Google Scholar 

  10. Fahrenberg HS: Freiburg Personality Inventory, 7th edn. 2001

  11. Ostendorf F: Freiburger Persönlichkeitsinventar (FPI-R) (und Replik zur Rezension). J Fahrenberg 18:81–86, 1997

    Google Scholar 

  12. Gardulf A, Bjorvell H, Gustafson R, Hammarstrom L, Smith CI: Safety of rapid subcutaneous gammaglobulin infusions in patients with primary antibody deficiency. Immunodeficiency 4:81–84, 1993

    PubMed  CAS  Google Scholar 

  13. Gardulf A, Hammarstrom L, Smith CI: Home treatment of hypogammaglobulinaemia with subcutaneous gammaglobulin by rapid infusion. Lancet 338:162–166, 1991

    Article  PubMed  CAS  Google Scholar 

Download references


We thank Prof. Hartmut Hecker, Hannover, for help with the statistics, and Barbara Frisch, Dr. Julia Horn, and Benjamin Gathmann, Freiburg, for cooperational support. This work was supported by Baxter, Germany, and grants of the German Research Counsil (DFG) GR1617/3 and SFB620 project C2.

Author information

Authors and Affiliations


Corresponding author

Correspondence to J. M. KITTNER.

Rights and permissions

Reprints and permissions

About this article

Cite this article

KITTNER, J.M., GRIMBACHER, B., WULFF, W. et al. Patients' Attitude to Subcutaneous Immunoglobulin Substitution as Home Therapy. J Clin Immunol 26, 400–405 (2006).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: