Abstract
The treatment of primary immunodeficiency disease (PIDD) patients with immunoglobulin obtained from healthy controls, given intravenously, is a relatively recent event, having first been given in 1981. Intravenous immunoglobulin (IVIG) replacement in PIDD has been shown to prevent serious/recurrent infections because higher IgG levels can be obtained through IV administration, as opposed to the intramuscular route. Significant variation in IgG levels in controls is dependent on age and sex, which provides the rationale for the concept that there is a “biological IgG trough/level”, hereafter called biological IgG level, in PIDD, as there is in healthy controls. Each PIDD patient has a biological IgG level that can be altered by comorbid conditions that evoke IgG loss or changes in metabolism/catabolism. The pharmacokinetic comparison of IVIG vs. SCIG demonstrates the various benefits of each in treating PIDD. Acutely ill PIDD patients should only receive IVIG. “Rush” SCIG treatment can also be used to attain the biological IgG level, but for less emergent care of PIDD. Finally, future opportunities exist to enhance IgG replacement in PIDD, including microbe-specific IgG and IgG subclass-specific enriched preparations.
Similar content being viewed by others
References
Buckley RH. Primary cellular immunodeficiencies. J Allergy Clin Immunol. 2002;109:747–57.
Eibl M. History of immunoglobulin replacement. Immunol Allergy Clin N Am. 2008;28:737–64.
Orbach H, Katz U, Sherer Y, Shoenfeld Y. Intravenous immunoglobulin: adverse effects and safe administration. Clin Rev Allergy Immunol. 2005;29(3):173–84.
Garcia-Lloret M, McGhee S, Chatila T. Immunoglobulin replacement therapy in children. Immunol Allergy Clin North Am. 2008;28(4):833–49.
Orange JS, Hossny EM, Weiler CR, et al. Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol. 2006;117:S525–53.
Hizentra Immune Globulin Subcutaneous [Human], 20 % Liquid [prescribing information]. Kankakee, IL: CSL Behring LLC; 2011.
Yong PL, Boyle J, Ballow M, Boyle M, Bonilla FA, Chinen J, Cunningham-Rundles C, Fuleihan R, Nelson L, Wasserman RL, Williams KC, Orange JS. Use of intravenous immunoglobulin and adjunctive therapies in the treatment of primary immunodeficiencies: a working group report of and study by the Primary Immunodeficiency Committee of the American Academy of Allergy Asthma and Immunology. Clin Immunol. 2010;135:255–63.
Bonagura VR, Marchlewski R, Cox A, Rosenthal DW. Biological IgG level in primary immunodeficiency disease: the IgG level that protects against recurrent infection. J Allergy Clin Immunol. 2008;122:210–1.
Orange JS, Grossman WJ, Navickis RJ, Wilkes MM. Impact of trough IgG on pneumonia incidence in primary immunodeficiency: a meta-analysis of clinical studies. Clin Immunol. 2010;137:21–30.
Lucas M, Lee M, Lortan J, Lopez-Granados E, Misbah S, Chapel H. Infection outcomes in patients with common variable immunodeficiency disorders: relationship to immunoglobulin therapy over 22 years. J Allergy Clin Immunol. 2010;125:1354–60.e4.
Chen Y, Stirling RG, Paul E, Hore-Lacy F, Thompson BR, Douglass JA. Longitudinal decline in lung function in patients with primary immunoglobublin deficiencies. J Allergy Clin Immunol. 2011;127:1414–17.
Conflict of Interest
Dr Bonagura has served as a member of the Primary Immunodeficiency Advisory Board for CSL Behring and Baxter Healthcare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bonagura, V.R. Using Intravenous Immunoglobulin (IVIG) to Treat Patients with Primary Immune Deficiency Disease. J Clin Immunol 33 (Suppl 2), 90–94 (2013). https://doi.org/10.1007/s10875-012-9838-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10875-012-9838-1