Immune globulin therapy in primary immunodeficiency
- Jordan S Orange, MD, PhD
Jordan S Orange, MD, PhD
- Section Editor — Immunology and Immunodeficiency
- Professor of Pediatrics
- Chief of Immunology, Allergy, and Rheumatology
- Baylor College of Medicine
- Texas Children's Hospital
Polyclonal immune globulin consists of immunoglobulins (mostly immunoglobulin G [IgG]) purified from pooled human plasma. Immune globulin is used to treat a wide variety of diseases, including primary and secondary immunodeficiency states and hematologic and autoimmune disorders .
Terminology — Immune globulin, intravenous (human) will be referred to as "IVIG" in this review, because this term is commonly used by clinicians, although the abbreviation preferred by various regulatory agencies is "IGIV." Immune globulin can also be administered subcutaneously. Immune globulin, subcutaneous (human) will be referred to as "SCIG."
The use of immune globulin in primary immunodeficiency will be reviewed here. General principles in the use of IVIG and SCIG and the role of these agents in the treatment of various hematologic and autoimmune disorders are presented separately. (See "Overview of intravenous immune globulin (IVIG) therapy".)
Comparisons of intravenous and subcutaneous therapy, both traditional and hyaluronidase-facilitated, are discussed elsewhere. (See "Subcutaneous and intramuscular immune globulin therapy".)
Immune globulin therapy is the mainstay of treatment for a variety of primary immunodeficiency states .
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- B cell immunodeficiencies
- Combined immunodeficiencies
- Other specific primary immunodeficiencies
- EFFICACY IN PREVENTING INFECTIONS
- Limitations of therapy
- CONSTITUENTS AND PRODUCTION METHODS
- Antibodies to specific antigens
- Other constituents
- INFORMED CONSENT/PATIENT INFORMATION
- Risks of therapy
- ADMINISTRATION AND DOSING
- Selecting a specific product
- Pretreatment testing
- Initial doses and schedules
- Trough levels
- Individualizing the dose
- - Determining a patient's threshold dose
- - "Wear-off" effects
- Patients with normal pretreatment IgG levels
- Monitoring and record keeping
- Duration of therapy
- Use in pregnancy
- SUMMARY AND RECOMMENDATIONS