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Subcutaneous and intramuscular immune globulin therapy

Author
Stephen Jolles, BSc Hons, MBChB Hons, MSc, PhD, MRCP, FRCPath
Section Editor
E Richard Stiehm, MD
Deputy Editor
Anna M Feldweg, MD

INTRODUCTION

Human immune globulin therapy is used for the treatment of immunodeficiency, prophylaxis of infectious diseases, and in the management of a variety of other inflammatory and autoimmune disorders. There are two main routes of administration: intravenous (IV) and subcutaneous (SC). A third route is intramuscular (IM), although this is uncommonly used, except for hyperimmune globulins (eg, rabies immune globulin). There are also three different methods of administering immune globulin subcutaneously: traditional, facilitated subcutaneous, and subcutaneous rapid-push.

The available preparations, dosing, administration, and adverse effects of SC and IM preparations of immune globulin will be reviewed here, particularly as used in antibody deficiency states. Comparisons between the methods of delivery are also discussed. Intravenous immune globulin (IVIG) is reviewed in greater detail elsewhere [1]. (See "Overview of intravenous immune globulin (IVIG) therapy" and "Immune globulin therapy in primary immunodeficiency" and "Intravenous immune globulin: Adverse effects".)

Background — SC injections of immune globulin were originally employed by Bruton in the first patient diagnosed with agammaglobulinemia and in a follow-up paper 10 years later in 1962 [2,3]. Bruton also used animal-derived hyaluronidase to facilitate IM administration [3]. However, when IV preparations became available, the IV route became preferred because of the larger volumes that could be administered. Subsequently, SC immune globulin dramatically gained popularity for routine replacement therapy in primary immunodeficiencies as clinicians became aware that SC administration was quicker and had fewer systemic adverse effects compared with IV administration [4,5].

IM preparations are now uncommonly used in the treatment of antibody deficiencies. However, intramuscular immune globulin (IMIG) can be given in single doses for short-term prevention of specific infectious diseases (eg, hepatitis A) following exposure or travel to a country where these disorders are endemic. Some hyperimmune globulins are animal antitoxins and antisera, and certain monoclonal antibody preparations are injected IM as well. (See "Plasma derivatives and recombinant DNA-produced coagulation factors", section on 'Hyperimmune globulins'.)

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.

                                        

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Literature review current through: Nov 2016. | This topic last updated: Tue Dec 22 00:00:00 GMT+00:00 2015.
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