Immunoglobulin therapy

Immunoglobulin therapy is the medical use of a mixture of antibodies, known as normal human immunoglobulin (NHIG), to treat a variety of immune system disorders. It is used primarily in conditions that involve primary immunodeficiency, autoimmune diseases, and some infectious diseases where a more specific immunoglobulin formulation is unavailable. Immunoglobulin therapy can be administered via intramuscular injection, intravenous infusion (IVIG), or subcutaneous injection (SCIG), depending on the formulation and the clinical indication. The therapeutic effects generally last for several weeks.

Medical Uses

Immunoglobulin therapy is indicated for various conditions that involve either a deficiency in antibody production or dysfunctional immune responses. These conditions include:

Primary Immunodeficiencies

Immunoglobulin therapy is a cornerstone treatment for individuals with primary immunodeficiency disorders (PIDs), in which the body is unable to produce adequate functional antibodies. Common PIDs treated with immunoglobulin replacement include:

• Common variable immunodeficiency (CVID)
• X-linked agammaglobulinemia (XLA)
• Severe combined immunodeficiency (SCID)
• Hyper IgM syndrome
• IgG subclass deficiency

Autoimmune and Neurological Disorders

Immunoglobulin therapy is also used to modulate immune system activity in a variety of autoimmune diseases and neuromuscular disorders, including:

• Immune thrombocytopenic purpura (ITP)
• Chronic inflammatory demyelinating polyneuropathy (CIDP)
• Guillain–Barré syndrome
• Myasthenia gravis
• Multiple sclerosis
• Stiff person syndrome
• Dermatomyositis
• Kawasaki disease

Secondary Immunodeficiencies

Individuals with secondary immunodeficiency due to human immunodeficiency virus (HIV) infection, certain cancers, or the use of immunosuppressive therapy may receive immunoglobulin therapy to reduce the risk of opportunistic infections. It is particularly useful in:

• Pediatric HIV infection
• Chronic lymphocytic leukemia (CLL)
• Multiple myeloma
• Immunosuppression following organ transplantation

Infectious Diseases and Post-Exposure Prophylaxis

Immunoglobulin therapy is used as a passive immunity measure in cases where immediate protection against an infection is required. It is particularly useful for:

• Measles (post-exposure prophylaxis in immunocompromised patients)
• Hepatitis B (hepatitis B immune globulin, HBIG)
• Rabies (rabies immune globulin, RIG)
• Tetanus (tetanus immune globulin, TIG)
• Varicella-zoster virus (varicella-zoster immune globulin, VZIG)
• Rh incompatibility (Rho(D) immune globulin)

Administration

The mode of administration of immunoglobulin therapy depends on the specific indication and patient needs:

• Intravenous immunoglobulin (IVIG) – Given via an intravenous infusion, typically every 3–4 weeks. It is commonly used for immunodeficiency disorders and autoimmune conditions.
• Subcutaneous immunoglobulin (SCIG) – Self-administered by patients at home, allowing for more stable immunoglobulin levels. It is often used in primary immunodeficiency management.
• Intramuscular immunoglobulin (IMIG) – Less commonly used due to the development of IVIG and SCIG, but still employed for post-exposure prophylaxis in some cases.

Side Effects and Risks

While generally well-tolerated, immunoglobulin therapy can cause several adverse effects:

Common Side Effects

• Injection site pain
• Headache
• Fatigue
• Muscle pain
• Nausea
• Fever

Serious Adverse Effects

• Anaphylaxis (especially in individuals with IgA deficiency and anti-IgA antibodies)
• Renal failure (associated with IVIG formulations containing sucrose)
• Hemolysis (red blood cell breakdown)
• Thrombosis (increased risk of blood clots)
• Aseptic meningitis

Production and Availability

Immunoglobulin therapy is derived from human blood plasma collected from thousands of donors. The antibodies present in the final product provide passive immunity against a wide range of infections. The manufacturing process includes plasma fractionation, purification, and viral inactivation to ensure safety.

The global demand for immunoglobulin therapy has increased significantly due to its expanded indications and the growing recognition of immune deficiency disorders. However, limited plasma donation availability and complex manufacturing processes have led to shortages and rationing in some regions.

History

The first documented use of human immunoglobulin therapy occurred in the 1930s. By the 1950s, intramuscular formulations were commonly used for post-exposure prophylaxis against infectious diseases. In 1981, the first intravenous formulation (IVIG) was approved for medical use in the United States. Since then, immunoglobulin therapy has become a critical treatment for a wide range of immunological conditions.

Related Pages

• Immunodeficiency
• Plasma donation
• Antibody therapy
• Immune system
• Autoimmune disease

Immunoglobulin therapy Resources
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