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February 1993, Vol 50, No. 2 >
Article | February 1993

Safety of Intravenous Immunoglobulin

Charles A. Thornton, MD
Arch Neurol. 1993;50(2):135-136. doi:10.1001/archneur.1993.00540020013009
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The current position of intravenous immunoglobulin (IVIG) in neurology is similar to that of plasmapheresis 10 years ago. Therapeutic claims have been made for an increasing number of neurologic disorders, based on small, uncontrolled studies. With the recent publication of a controlled trial of IVIG treatment in Guillain-Barré syndrome,1 and trials in chronic inflammatory demyelinating polyneuropathy and inflammatory myopathy in progress or nearing completion, increasing use of IVIG by neurologists can be expected. A major factor fueling the current interest in IVIG is its relative safety. It is regarded by some as "virtually riskless."2 Even so, potential toxicity should be considered when evaluating therapeutic claims and prescribing IVIG treatment.

Commercial IVIG is human IgG prepared from the pooled plasma of 2000 to 10000 or more donors to maximize the diversity of antibodies of the final product. Because the antibody repertoire of the species is much larger than that

REFERENCES

1 +
van der Meché FGA, Schmitz PIM, and the Dutch Guillain-Barré Study Group.  A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome . N Engl J Med . 1992;;326:1123-1129.
2 +
Cosi V, Lombardi M, Piccolo G, Erbetta A.  Treatment of myasthenia gravis with high-dose intravenous immunoglobulin . Acta Neurol Scand . 1991;;84:81-84.
3 +
Roux KH, Tankersley DL.  A view of the human idiotypic repertoire: electron microscopic and immunologic analyses of spontaneous idiotype-anti-idiotype dimers in pooled human IgG . J Immunol . 1990;;144:1387-1395.
4 +
Parslow TG.  Immunoglobulin genetics . In: Stites DP, Terr Al, eds. Basic and Clinical Immunology . Norwalk, Calif: Appleton and Lange; 1991;.
5 +
Barandun S, Isliker H.  Development of immunoglobulin preparations for intravenous use . Vox Sang . 1986;;51:157-160.
6 +
Barandun S, Kistler P, Jeunet F, Isliker H.  Intravenous administration of human gammaglobulin . Vox Sang . 1962;;7:157-174.
7 +
Björkander J, Hammarström L, Smith CIE, Buckley RH, Cunningham-Rundles C, Hanson LA.  Immunoglobulin prophylaxis in patients with antibody deficiency syndromes and anti-IgA antibodies . J Clin Immunol . 1987;;7:8-15.
8 +
Cassidy JT, Nordby GL.  Human serum immunoglobulin concentrations: prevalence of immunoglobulin deficiencies . J Allergy Clin Immunol . 1975;;55:35-48.
9 +
 NIH Consensus Conference. Intravenous immunoglobulin: prevention and treatment of disease . JAMA . 1990;;264:3189-3193.
10 +
Copelan EA, Strohm PL, Kennedy MS, Tutschka PJ.  Hemolysis following intravenous immune globulin therapy . Transfusion . 1986;;26: 410-412.
11 +
Nydegger UE.  Intravenous immunoglobulin in combination with other prophylactic and therapeutic measures . Transfusion . 1992;;32:72-82.
12 +
Chan-Lam D, Fitzsimons EJ, Douglas WS.  Alopecia after immunoglobulin infusion . Lancet . 1987;;1:1436.
13 +
Casteels-Van Daele M, Wijndaele L, Hunninck K.  Intravenous immune globulin and acute aseptic meningitis . N Engl J Med . 1990;;323:614-615.
14 +
Ayliffe W, Haeney M, Roberts SC, Lavin M.  Uveitis after antineutrophil cytoplasmic antibody contamination of immunoglobulin replacement therapy . Lancet . 1992;;339:558-559.
15 +
Acres MD.  Safety of therapeutic immune globulin preparations with respect to transmission of human T-lymphotrophic virus type III/lymphadenopathy-associated virus infection . MMWR . 1986;;35:231-233.
16 +
Mitra G, Wong MF, Mozen MM, McDougal JS, Levy JA.  Elimination of infectious retroviruses during preparation of immunoglobulins . Transfusion . 1986;;26:394-397.
17 +
Lever AM, Webster ADB, Brown D, Thomas HC.  Non-A, non-B hepatitis occurring in agammaglobulinemic patients after intravenous immunoglobulin . Lancet . 1984;;2:1062-1064.
18 +
Ochs HD, Fischer SH, Virant FS, Lee ML, Kingdon HS, Wedgwood RJ.  Non-A, non-B hepatitis and intravenous immunoglobulin . Lancet . 1985;;1:404-405.
19 +
Björkander J, Cunningham-Rundles C, Lundin P, Olsson R, Soderstrom R, Hanson LA.  Intravenous immunoglobulin prophylaxis causing liver damage in 16 of 77 patients with hypogammaglobulinemia or IgG subclass deficiency . Am J Med . 1988;;84:107-111.
20 +
Williams PE, Yap PL, Gillon J, Crawford RJ, Urbaniak SJ, Galea C.  Transmission of non-A, non-B hepatitis by pH4-treated intravenous immunoglobulin . Vox Sang . 1989;;57:15-18.
21 +
Tan E, Hajinazarian M, Bay W, Neff J, Mendell JR.  Acute renal failure resulting from intravenous immunoglobulin therapy . Arch Neurol . 1993;;50:137-139.
22 +
Corvetta A, Della Bitta R, Gabrielli A, Spaeth PJ, Danieli G.  Use of high-dose intravenous immunoglobulin in systemic lupus erythematosus: report of three cases . Clin Exp Rheum . 1989;; 7:295-299.
23 +
Rault R, Piraino B, Johnston JR, Oral A.  Pulmonary and renal toxicity of intravenous immunoglobulin . Clin Nephrol . 1991;;36:83-86.
24 +
Schifferli J, Leski M, Favre H, Imbach P, Nydegger U, Davies K.  High-dose intravenous IgG treatment and renal function . Lancet . 1991;; 337:457-458.
25 +
Jordan SC.  Intravenous gamma globulin therapy in systemic lupus erythematosus and immune complex disease . Clin Immunol Immunopathol . 1989;;53:S164-S169.
26 +
Anderson WAD, Bethea WR.  Renal lesions following administration of hypertonic solutions of sucrose: report of six cases . JAMA . 1940;;114: 1983-1987.
27 +
Cutler HH.  Effects of sucrose on the kidney . Proc Staff Meet Mayo Clin . 1939;;14:318-320.
28 +
Dorman HR, Sondheimer JH, Cadnapaphornchai P.  Mannitol-induced acute renal failure . Medicine . 1990;;69:153-159.

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1 +
van der Meché FGA, Schmitz PIM, and the Dutch Guillain-Barré Study Group.  A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome . N Engl J Med . 1992;;326:1123-1129.
2 +
Cosi V, Lombardi M, Piccolo G, Erbetta A.  Treatment of myasthenia gravis with high-dose intravenous immunoglobulin . Acta Neurol Scand . 1991;;84:81-84.
3 +
Roux KH, Tankersley DL.  A view of the human idiotypic repertoire: electron microscopic and immunologic analyses of spontaneous idiotype-anti-idiotype dimers in pooled human IgG . J Immunol . 1990;;144:1387-1395.
4 +
Parslow TG.  Immunoglobulin genetics . In: Stites DP, Terr Al, eds. Basic and Clinical Immunology . Norwalk, Calif: Appleton and Lange; 1991;.
5 +
Barandun S, Isliker H.  Development of immunoglobulin preparations for intravenous use . Vox Sang . 1986;;51:157-160.
6 +
Barandun S, Kistler P, Jeunet F, Isliker H.  Intravenous administration of human gammaglobulin . Vox Sang . 1962;;7:157-174.
7 +
Björkander J, Hammarström L, Smith CIE, Buckley RH, Cunningham-Rundles C, Hanson LA.  Immunoglobulin prophylaxis in patients with antibody deficiency syndromes and anti-IgA antibodies . J Clin Immunol . 1987;;7:8-15.
8 +
Cassidy JT, Nordby GL.  Human serum immunoglobulin concentrations: prevalence of immunoglobulin deficiencies . J Allergy Clin Immunol . 1975;;55:35-48.
9 +
 NIH Consensus Conference. Intravenous immunoglobulin: prevention and treatment of disease . JAMA . 1990;;264:3189-3193.
10 +
Copelan EA, Strohm PL, Kennedy MS, Tutschka PJ.  Hemolysis following intravenous immune globulin therapy . Transfusion . 1986;;26: 410-412.
11 +
Nydegger UE.  Intravenous immunoglobulin in combination with other prophylactic and therapeutic measures . Transfusion . 1992;;32:72-82.
12 +
Chan-Lam D, Fitzsimons EJ, Douglas WS.  Alopecia after immunoglobulin infusion . Lancet . 1987;;1:1436.
13 +
Casteels-Van Daele M, Wijndaele L, Hunninck K.  Intravenous immune globulin and acute aseptic meningitis . N Engl J Med . 1990;;323:614-615.
14 +
Ayliffe W, Haeney M, Roberts SC, Lavin M.  Uveitis after antineutrophil cytoplasmic antibody contamination of immunoglobulin replacement therapy . Lancet . 1992;;339:558-559.
15 +
Acres MD.  Safety of therapeutic immune globulin preparations with respect to transmission of human T-lymphotrophic virus type III/lymphadenopathy-associated virus infection . MMWR . 1986;;35:231-233.
16 +
Mitra G, Wong MF, Mozen MM, McDougal JS, Levy JA.  Elimination of infectious retroviruses during preparation of immunoglobulins . Transfusion . 1986;;26:394-397.
17 +
Lever AM, Webster ADB, Brown D, Thomas HC.  Non-A, non-B hepatitis occurring in agammaglobulinemic patients after intravenous immunoglobulin . Lancet . 1984;;2:1062-1064.
18 +
Ochs HD, Fischer SH, Virant FS, Lee ML, Kingdon HS, Wedgwood RJ.  Non-A, non-B hepatitis and intravenous immunoglobulin . Lancet . 1985;;1:404-405.
19 +
Björkander J, Cunningham-Rundles C, Lundin P, Olsson R, Soderstrom R, Hanson LA.  Intravenous immunoglobulin prophylaxis causing liver damage in 16 of 77 patients with hypogammaglobulinemia or IgG subclass deficiency . Am J Med . 1988;;84:107-111.
20 +
Williams PE, Yap PL, Gillon J, Crawford RJ, Urbaniak SJ, Galea C.  Transmission of non-A, non-B hepatitis by pH4-treated intravenous immunoglobulin . Vox Sang . 1989;;57:15-18.
21 +
Tan E, Hajinazarian M, Bay W, Neff J, Mendell JR.  Acute renal failure resulting from intravenous immunoglobulin therapy . Arch Neurol . 1993;;50:137-139.
22 +
Corvetta A, Della Bitta R, Gabrielli A, Spaeth PJ, Danieli G.  Use of high-dose intravenous immunoglobulin in systemic lupus erythematosus: report of three cases . Clin Exp Rheum . 1989;; 7:295-299.
23 +
Rault R, Piraino B, Johnston JR, Oral A.  Pulmonary and renal toxicity of intravenous immunoglobulin . Clin Nephrol . 1991;;36:83-86.
24 +
Schifferli J, Leski M, Favre H, Imbach P, Nydegger U, Davies K.  High-dose intravenous IgG treatment and renal function . Lancet . 1991;; 337:457-458.
25 +
Jordan SC.  Intravenous gamma globulin therapy in systemic lupus erythematosus and immune complex disease . Clin Immunol Immunopathol . 1989;;53:S164-S169.
26 +
Anderson WAD, Bethea WR.  Renal lesions following administration of hypertonic solutions of sucrose: report of six cases . JAMA . 1940;;114: 1983-1987.
27 +
Cutler HH.  Effects of sucrose on the kidney . Proc Staff Meet Mayo Clin . 1939;;14:318-320.
28 +
Dorman HR, Sondheimer JH, Cadnapaphornchai P.  Mannitol-induced acute renal failure . Medicine . 1990;;69:153-159.

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