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Intravenous immunoglobulin

Adverse effects and safe administration

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Abstract

Intravenous immunoglobulin (IVIg) is administered for various indications and generally considered a safe therapy. Most of the adverse effects (AEs) associated with IVIg administration are mild and transient. The immediate AEs include headache, flushing, malaise, chest tightness, fever, chills, myalgia, fatigue, dyspnea, back pain, nausea, vomiting, diarrhea, blood pressure changes, tachycardia, and anaphylactic reactions, especially in IgA-deficient patients. Late AEs are rare and include acute renal failure, thromboembolic events, aseptic meningitis, neutropenia, and autoimmune hemolytic anemia, skin reactions, and rare events of arthritis. Pseudohyponatremia following IVIg is important to be recognized. Renal failure, usually oliguric and transient, occurs mostly on using sucrose-containing products owing to osmotic injury. Among high-risk patients who have a previous renal disease, dehydration, diabetes mellitus, advanced age, hypertension, hyperviscosity, or are treated by other nephrotoxic medications, administration of a non-sucrose-containing IVIg product after accomplishing hydration, in a low concentration and a slow infusion rate while supervising urine output and kidney function, is recommended. Thromboembolic complications occur because of hyperviscosity especially in patients having risk factors including advanced age, previous thromboembolic diseases, being bedridden, diabetes mellitus, hypertension, dyslipidemia, or those receiving high-dose IVIg in a rapid infusion rate. Immediate AEs can be treated by the slowing or temporary discontinuation of the infusion and symptomatic therapy with analgesics, non-steroidal anti-inflammatory drugs, antihistamines, and glucocorticoids in more severe reactions. Slow infusion rate of low concentration of IVIg products and hydration, especially in high-risk patients, may prevent renal failure, thromboembolic events, and aseptic meningitis.

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References

  1. Weisman, L. E. (1994), Isr J Med Sci 30, 459–463.

    PubMed  CAS  Google Scholar 

  2. Bertorini, T. E., Nance, A. M., Horner, L. A., et al. (1996), Muscle Nerve 19, 388–391.

    Article  PubMed  CAS  Google Scholar 

  3. Brannagan, T. H., Nagle, K. J., Lange, D. J., et al. (1996), Neurology 47, 674–677.

    PubMed  Google Scholar 

  4. Al Wahadneh, A. M., Khriesat, I.A., and Kuda, E. H. (2000), Saudi Med J 21, 953–956.

    Google Scholar 

  5. Sherer, Y., Levy, Y., Langevitz, P., et al. (2001), Pharmacology 62, 133–137.

    Article  PubMed  CAS  Google Scholar 

  6. Wittstock, M., Benecke, R., and Zettl, U. K. (2003), Eur Neurol 50, 172–175.

    Article  PubMed  CAS  Google Scholar 

  7. Colovic, M., Dimitrijevic, M., Sonnenberg, C., et al. (2003), Hematol J 4, 358–362.

    Article  PubMed  CAS  Google Scholar 

  8. Stangel, M., Kiefer, R., Pette, M., et al. (2003), J Neurol 250, 818–821.

    Article  PubMed  Google Scholar 

  9. Knezevic-Marmarica, I., and Kruskall, M. S. (2003), Transfusion 43, 1460–1480.

    Article  Google Scholar 

  10. Pierce, L. R. and Jain, N. (2003), Transfus Med Rev 17, 241–251.

    Article  PubMed  Google Scholar 

  11. Aghamohammadi, A., Farhoudi, A., Nikzad, M., et al. (2004), Ann Allergy Asthma Immunol 92, 60–64.

    Article  PubMed  CAS  Google Scholar 

  12. Reutter, A. and Luger, T. A. (2004), Am J Clin Dermatol 5, 153–160.

    Article  Google Scholar 

  13. Marinos, C. and Dalakas, M. C. (2004), Pharmacol Therapeut 102, 177–193.

    Article  CAS  Google Scholar 

  14. Nydegger, U. E. and Sturzenegger, M. (1999), Drug Safety 21, 171–185.

    Article  PubMed  CAS  Google Scholar 

  15. Kazatchkine, M. D. and Kaveri, S, V. (2001), N Engl J Med 345, 747–755.

    Article  PubMed  CAS  Google Scholar 

  16. Salama, A., Temmesfeld, B., Hippenstiel, S., et al. (2004), Transfusion 44, 509–511.

    Article  PubMed  Google Scholar 

  17. NIH Consensus Conference. (1990), JAMA 264, 3189–3193.

    Article  Google Scholar 

  18. Orbach, H., Tishler, M., and Shoenfeld, Y. (2004), Semin Arthritis Rheum 34, 593–601.

    Article  PubMed  CAS  Google Scholar 

  19. Windrum, P., Bharucha, C., and Desai, Z. R. (1998), Br J Haematol 101, 592.

    Article  PubMed  CAS  Google Scholar 

  20. McColl, M. D., Omran, A., Walker, I. D., et al. (1999), Haemophilia 5, 124–126.

    Article  PubMed  CAS  Google Scholar 

  21. Khalil, M., Shin, H. J., Tan, A., et al. (2000), Acta Cytol 44, 86–90.

    PubMed  CAS  Google Scholar 

  22. Bassilios, N., Mercadal, L., and Deray, G. (2001) Nephrol Dial Transplant 16, 1513–1514.

    Article  PubMed  CAS  Google Scholar 

  23. Akhtar, I. and Bastani, B. (2003), Ann Intern Med 139, W65.

  24. Chapman, S., Glikerson, K. L., Davin, T. D., et al. (2004), Ann Pharmacother 38, 2059–2067.

    Article  PubMed  Google Scholar 

  25. Renal insufficiency and failure associated with immune globulin intravenous therapy—United States, 1985–1998. (1999), MMWR Morb Mortal Wkly Rep 48, 518–522.

    Google Scholar 

  26. Gras, V., Andrejak, M., and Decocq, G. (1999) Pharmacoepidemiol Drug Safety 8, S73-S78.

    Article  Google Scholar 

  27. Epstein, J. S., Gaines, A., Kapit, R., et al. (summer 1999), FDA Med Bull.

  28. Yerba, M., Barrios, Y., Rincon, J., et al. (2002), Clin Exp Rheumatol 20, 225–227.

    Google Scholar 

  29. Shoenfeld, Y. and Krause, I. (2004), J Clin Immunol 24, 107–114.

    Article  PubMed  CAS  Google Scholar 

  30. Katz, U. and Shoenfeld, Y. (2005), Lupus in press.

  31. Durand, J. M., Lefevre, P., Kaplanski, G., Retornaz, F., Cretel, E. and Soubeyrand, J. (1993), Am J Hematol 44, 214–215.

    Article  PubMed  CAS  Google Scholar 

  32. Oh, K. T., Boldt, H. C., and Danis, R. P. (1997), Am J Ophthalmol 124, 416–418.

    PubMed  CAS  Google Scholar 

  33. Rosenbaum, J.T. (1997), Arthritis Rheum 40, 1732–1733.

    PubMed  CAS  Google Scholar 

  34. Go, R.S. and Call, T. G. (2000), Mayo Clin Proc 75, 83–85.

    Article  PubMed  CAS  Google Scholar 

  35. Turner, B. and Wills, A. J. (2000), J Neurol Neurosurg Psychiatry 68, 790–791.

    Article  PubMed  CAS  Google Scholar 

  36. Elkayam, O., Paran, D., Milo, R., et al. (2000), Ann Rheum Dis 59, 77–80.

    Article  PubMed  CAS  Google Scholar 

  37. Emerson, G. G., Herndon, C. N., and Sreih, A.G. (2002), Pharmacotherapy 22, 1638–1641.

    Article  PubMed  Google Scholar 

  38. Katz, K. A., Hivnor, C. M., Geist, D. E., et al. (2003), Arch Dermatol 139, 991–993.

    Article  PubMed  Google Scholar 

  39. Zaidan, R., Al Moallem, M., Wani, B. A., et al. (2003), Eur J Neurol 10, 367–372.

    Article  PubMed  CAS  Google Scholar 

  40. Evangelou, N., Littlewood, T., Ansow, P., and Chapel, H. (2003), J Clin Pathol 56, 308–309.

    Article  PubMed  CAS  Google Scholar 

  41. Okuda, D., Flaster, M., Frey, J., and Sivakumar, K. (2003), Neurology 60, 1825–1826.

    PubMed  Google Scholar 

  42. Brown, H. C. and Ballas, Z. K. (2003), J Allergy Clin Immunol 112, 797–799.

    Article  PubMed  Google Scholar 

  43. Sheehan, D. J. and Lesher, J. L. Jr. (2004), Cutis 73, 403–406.

    PubMed  Google Scholar 

  44. Vucic, S., Chong, P. S., Dawson, K. T., et al. (2004), Eur Neurol 52, 141–144.

    Article  PubMed  CAS  Google Scholar 

  45. Caress, J. B., Cartwright, M. S., Donofrio, P. D., et al. (2003), Neurology 60, 1822–1824.

    PubMed  CAS  Google Scholar 

  46. Dalakas, M. C. and Clark, W. M. (2003), Neurology 60, 1736–1737.

    Article  PubMed  Google Scholar 

  47. Reinhart, W.H. and Berchtold, P. E. (1992), Lancet 339, 662–664.

    Article  PubMed  CAS  Google Scholar 

  48. Dalakas, M. C. (1994), Neurology 44, 223–226.

    PubMed  CAS  Google Scholar 

  49. Steinberger, B A., Ford, S. M., and Coleman, T.A. (2003), Am J Hematol 73, 97–100.

    Article  PubMed  Google Scholar 

  50. Sequl, E. A., Cupler, E. J., and Dalakas, M. C. (1994), Ann Intern Med 121, 259–262.

    Google Scholar 

  51. Nettis, E., Calogiuri, G., Colandari, M. C., et al. (2003), Curr Drug Targets Immune Endocr Metabol Disord 3, 143–149.

    Article  PubMed  CAS  Google Scholar 

  52. Jolles, S., Sewell, W. A., and Leighton, C. (2000) Drug Safety 22, 215–226.

    Article  PubMed  CAS  Google Scholar 

  53. Matsuda, M., Hosoda, W., Sekijima, Y., et al. (2003), Clin Neuropharmacol 6, 306–311.

    Article  Google Scholar 

  54. Kessary-Shoham, H., Levy, Y., Shoenfeld, Y., et al. (1999), J Autoimmun 13, 129–135.

    Article  PubMed  CAS  Google Scholar 

  55. Nakagawa, M., Watanabe, N., Okuno, M., et al. (2000), Am J Hematol 63, 160–161.

    Article  PubMed  CAS  Google Scholar 

  56. Miyamae, T., Kurosawa, R., Mori, M., et al. (2004), Med Rheumatol 14, 314–319.

    Article  Google Scholar 

  57. Barbaud, A., Trechot, P., Granel, F., et al. (1999), Dermatology 199, 258–260.

    Article  PubMed  CAS  Google Scholar 

  58. Lawn, N., Wijdicks, E. F. M., and Buritt, M. F. (1998), N Engl J Med 339, 632.

    Article  PubMed  CAS  Google Scholar 

  59. Rizk, A., Gorson, K. C., Kenney, L., et al. (2001), Transfusion 41, 264–268.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine B, Wolfson Medical Center, Holon, Israel

    Hedi Orbach

  2. Center for Autoimmune Diseases, Department of Medicine B, Sheba Medical Center, Tel Hashomer

    Uriel Katz, Yaniv Sherer & Yehuda Shoenfeld

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Uriel Katz, Yaniv Sherer & Yehuda Shoenfeld

  4. Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel Aviv University, Tel Aviv, Israel

    Yehuda Shoenfeld

Authors
  1. Hedi Orbach
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  2. Uriel Katz
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  3. Yaniv Sherer
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  4. Yehuda Shoenfeld
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Correspondence to Yehuda Shoenfeld.

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Orbach, H., Katz, U., Sherer, Y. et al. Intravenous immunoglobulin. Clinic Rev Allerg Immunol 29, 173–184 (2005). https://doi.org/10.1385/CRIAI:29:3:173

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  • DOI: https://doi.org/10.1385/CRIAI:29:3:173

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