INTRODUCTION AND OVERVIEW
Adverse reactions are reported in up to 20 percent of all intravenous immune globulin infusions . The majority of adverse reactions are minor and transient; common examples include headache and mild rate-related reactions, such as chills or flushing. However, potentially serious systemic reactions of various types occur in 2 to 6 percent of patients . These include thrombotic, renal, hematologic, and neurologic complications, as well as rare true anaphylactic reactions [3,4]. Many of these adverse effects are reduced by administering immune globulin subcutaneously, instead of intravenously.
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 used by industry and various regulatory agencies is "IGIV."
Timing of reactions — Possible adverse effects may be divided by organ system (the approach used in this review) or by timing of onset, ie, immediate or delayed. Immediate reactions occur during the infusion, per se, and include rate-related reactions, true IgE-mediated anaphylaxis (in IgA-deficient patients), headache, and reactions related to concurrent infection. Delayed reactions generally occur hours to days after the infusion, and include headache/aseptic meningitis, acute kidney injury, hemolysis, venous thrombosis, and the possibility of myocardial infarction, transient ischemic attacks, and stroke. Some of these, particularly thrombotic events, may also occur during infusions, however.
The adverse effects attributed to IVIG will be reviewed here. General principles of immune globulin therapy, subcutaneous and intramuscular administration, and the use of IVIG in primary immunodeficiency, autoimmune, and hematologic disease are discussed separately. (See "General principles in the use of immune globulin" and "Subcutaneous and intramuscular immune globulin therapy" and "Immune globulin therapy in primary immunodeficiency" and "Intravenous immune globulin in hematologic disorders".)
Rate-related reactions are relatively common and are rarely serious. In general, these reactions involve constellations of symptoms of two general types [5,6]: