How does IVIG work for lupus?
In autoimmune diseases like lupus, the treatment may help your body raise low red-blood-cell counts. Not enough of these and you can become anemic and feel very tired. IVIg helps stop the white blood cells of people with lupus from destroying their red blood cells.
Does switching from IVIG to SCIG reduce immunoglobulin-induced adverse effects?
Switching from IVIG to SCIG seems to be an effective strategy that attenuates immunoglobulin-induced adverse effects, especially for patients who have previously experienced severe adverse effects or are at high risk of developing adverse effects.
How does IVIG treat myositis and autoimmune diseases?
In autoimmune diseases like lupus, the treatment may help your body raise low red-blood-cell counts. Not enough of these and you can become anemic and feel very tired. IVIg helps stop the white blood cells of people with lupus from destroying their red blood cells. In people with myositis, the treatment may block your immune system’s...
What are the risks of IVIG?
It turns out that, in these rare situations, IVIg can block the person’s own white blood cells from gobbling up and destroying platelets or red blood cells, which can cause autoimmune thrombocytopenia and autoimmune hemolytic anemia, respectively. IVIg can also favorably affect immune system function.
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Does IVIg affect antibody tests?
We identified a high specificity but reduced sensitivity for anti-neural antibody testing after IVIg transfusion. In contrast, antinuclear antibody testing is not reliable after IVIg treatment. These results are of high practical importance for diagnostic of neuroimmunological diseases.
Does IVIg suppress antibody production?
Exerts immunosuppressive action by suppressing the proliferation of B-lymphocytes and, thus, modulation of antibody production. [53] IVIG can also induce suppression of autoreactive B lymphocytes and neutralization of their cytokines.
Does IVIg interfere with monoclonal antibodies?
Monoclonal Antibodies That Mimic the Action of Intravenous Immunoglobulin Can Inhibit Immune Thrombocytopenia. Intravenous immunoglobulin (IVIG) is prepared from large pools of plasma from healthy donors and is widely used to treat autoimmune diseases, especially immune thrombocytopenic purpura (ITP).
How does IVIg affect the immune system?
IVIg gives you antibodies that your body is not making on its own so you can fight infections. In autoimmune diseases like lupus, the treatment may help your body raise low red-blood-cell counts. Not enough of these and you can become anemic and feel very tired.
Does IVIG increase IgG levels?
In GBS, patients show a large variability in serum immunoglobulin G (IgG) levels after standard IVIg treatment and a large increase in serum IgG levels (ΔIgG) was associated with a better outcome. Whether this is also the case in CIDP is not known.
Does IVIG raise IgM levels?
How is it taken? IVIg is given through a drip into a vein, this is known as intravenous infusion. It is sometimes given as an injection into a muscle if you're only taking it to increase your immunoglobulin levels following other treatments.
Is IVIg and monoclonal antibodies the same thing?
Apart from differences in glycosylation, the biggest difference between IVIg and monoclonal antibodies is the enormous diversity of sequences from the variable regions in the IVIg preparations, which are derived from several thousand donors.
Does IVIg help with Covid?
High-dose intravenous immunoglobulin (IVIG) improves outcomes for individuals who have critical and severe COVID-19, according to the results of a study published in International Immunopharmacology. The findings also showed that patient selection and timing are important factors when administering IVIG.
Are monoclonal antibodies the same as immunoglobulins?
Monoclonal antibodies (mAb or moAb) are identical immunoglobulins, generated from a single B-cell clone. These antibodies recognize unique epitopes, or binding sites, on a single antigen.
How does immunoglobulin therapy lower IgM levels?
Treatment of Hyper IgM Syndromes (See chapter titled “Immunoglobulin Therapy and Other Medical Therapies for Antibody Deficiencies.”) The immunoglobulin replaces the missing IgG and often results in a reduction or normalization of the serum IgM level.
Does IVIG protect against viruses?
Intravenous immunoglobulins (IVIG) are produced from thousands of pooled plasma donations, and thus contain a wide variety of antibodies the donors have generated against infectious disease agents. IVIG can therefore protect people with immune deficiencies against circulating bacterial and viral infections.
How does IVIG increase platelet count?
Antibodies are a type of protein. IVIG contains antibodies that bind to the cells in the spleen, which keeps these cells from destroying the platelets. More platelets stay in the blood, and your child's platelet count goes up.
What is the mechanism of action of IVIG?
The mechanism of action of IVIg in the treatment of autoimmune diseases is still a matter of debate. Generally speaking, one can discriminate between functions of the Fcγ region and the F (ab) 2 region and their effects on a cellular level ( Figure 1 ). These functions are not mutually exclusive, and given the heterogeneity of diseases IVIgs are used to treat, it is not unlikely that more than one pathway contributes to the beneficial effects. Indeed, there may be some truth to the statement that, after corticosteroids, IVIgs are the broadest immunomodulatory agent available ( 9 ).
When was IVIG first used?
From a historical perspective, the first well-documented proof-of-concept medical application of IVIg in an autoimmune disease dates back to 1981 , when Imbach et al. ( 1) successfully treated a child with immune thrombocytopenia (ITP, formerly idiopathic thrombocytopenic purpura), a humoral and cellular autoimmune reaction against thrombocytes and megakaryocytes that results in skin purpura and organ hemorrhage. Only a few years later, Furusho et al. ( 2) and Newburger et al. ( 3) reported the successful application of IVIg in Kawasaki disease, an acute, highly febrile necrotizing systemic vasculitis that mainly affects young children, often manifests with a mucocutaneous rash and unilateral cervical lymphadenopathy, and can be complicated by potentially fatal cardiovascular involvement. Even though, to date, no randomized clinical trial exists, IVIg has since become a mainstay in the treatment of Kawasaki disease. As early as 1993, Dalakas et al. ( 4) reported the first randomized controlled clinical trial of IVIg in a dermatological condition demonstrating its successful application in dermatomyositis. Subsequently, IVIg has evolved as a treatment for several other dermatological autoimmune conditions, which are listed in Table 1. The clinical application of IVIg is, however, limited by its high cost. Therefore, to warrant a rational use of IVIg, a comprehensive clinical guideline for the use of IVIg in dermatology was first published by the European Dermatology Forum in 2009 and was recently updated in its third edition ( 5 ).
What are the side effects of a syringe?
More common side effects, experienced by up to 10% of patients, include nausea, headache, fatigue, and febrile infusion reactions. Oftentimes, these mild side effects can be controlled by improved hydration; modification of the infusion speed; or anti-allergic, analgesic, and antipyretic co-medication.
Is IVIG used for autoimmune disease?
IVIg is successfully used to treat an expanding range of autoimmune diseases. While strong evidence points toward a prominent role of the Fcγ fragment to convey the beneficial effects of IVIg treatment, there may be more than one mechanism of action, and their precise role may vary depending on the disease in focus.
Is IVIG good for lupus?
According to the European guideline, IVIg should be considered as a treatment option in all cases of severe lupus erythematosus ( 5 ). In particular, IVIg may be beneficial in the treatment of pregnant women, SLE-associated ITP, stable lupus nephritis, and neuropsychiatric disease ( 53 ).
Is IL4 important for IVIG?
It should be noted, however, that previous research has suggested that IL33 and IL4 are not crucial for the beneficial effects of IVIg in murine ITP models, and patients with ITP still respond to IVIg after splenectomy ( 20, 21 ).
Is hemolysis a side effect of neutropenia?
Hemolysis and neutropenia, which are mostly mild, are thought to occur due to transferred blood-group antibodies and anti-neutrophil antibodies, respectively. Serious side effects are rare and include thrombosis and embolism, pulmonary edema, renal failure, aseptic meningitis, and severe anaphylactic reactions.
What is IVIg used for?
Intravenous immunoglobulin (IVIg) is administered both for the treatment of immunodeficiencies and for an expanding list of autoimmune diseases. Most adverse effects are mild and transient including headaches, flushing, fever, chills, fatigue, nausea, diarrhea, blood pressure changes and tachycardia. IgA deficiency-related anaphylactic reactions ...
What is IVIG in medicine?
Intravenous immunoglobulin (IVIg) is administered both for the treatment of immunodeficiencies and for an expanding list of autoimmune diseases. Most adverse effects are mild and transient including headaches, flushing, fever, chills, fatigue, nausea, diarrhea, blood pressure changes and tachycardia ….
Is IVIG safe?
Safety of intravenous immunoglobulin (IVIG) therapy. Intravenous immunoglobulin (IVIg) is administered both for the treatment of immunodeficiencies and for an expanding list of autoimmune diseases. Most adverse effects are mild and transient including headaches, flushing, fever, chills, fatigue, nausea, diarrhea, ...
How does IVIG work?
Investigators at Hospital for Special Surgery in New York City have discovered that intravenous immune globulin (IVIG) or antibody therapy works, in part, by attaching to a receptor known as FcgRIII and blocking the function of interferon gamma, a major inflammatory factor. Only a small component of the IVIG solution, 0.5%, is responsible for blocking this receptor.
What is the IgG of IVIG?
IVIG is composed of 99.5% monomeric IgG and 0.5% so-called immune complexes. The researchers cultured macrophages with the different IVIG components and discovered that the immune complexes were ...
What is the function of IVIG?
Investigators at Hospital for Special Surgery in New York City have discovered that intravenous immune globulin (IVIG) or antibody therapy works, in part, by attaching to a receptor known as FcgRIII and blocking the function of interferon gamma, a major inflammatory factor.
What is IVIG used for?
For years, doctors have used IVIG to treat patients with autoimmune and chronic inflammatory diseases, such as dermatomyositis, Kawasaki disease, multiple sclerosis, lupus, chronic lymphocytic leukemia, and idiopathic thrombocytopenic purpura, but just how the therapy works has remained a mystery.
How long does IVIG take?
Usually, patients must receive IVIG infusions in the hospital setting, which can involve three to four hours per day, for three consecutive days. “IVIG is time intensive, it’s somewhat expensive, and there are sometimes shortages, because it’s a human product,” Dr. Ivashkiv explained.
How does IVIG help?
Then it can be given to you through a vein in your arm, or IV. If you get IVIg, it can help strengthen your immune system so you can fight infections and stay healthy.
What is IVIG therapy?
Intravenous Immunoglobulin Therapy (IVIg) This therapy can help people with weakened immune systems or other diseases fight off infections. Some of the diseases that intravenous immunoglobulin ( IVIg) can treat include: People who receive bone marrow transplants may also use IVIg to prevent infections.
When do you feel your best after immunotherapy?
You might feel your best soon after your treatment, when the highest amount of immunoglobulin is in your body. As your body absorbs it , though, you may start to feel more weak or tired. You might feel your worst just before your next treatment.
Does IVIG help with lupus?
Not enough of these and you can become anemic and feel very tired. IVIg helps stop the white blood cells of people with lupus from destroying their red blood cells . In people with myositis, the treatment may block your immune system’s destruction of muscle cells.
Does IVIG help with autoimmune disease?
This puts you at greater risk for infections that could make you very sick. IVIg gives you antibodies that your body is not making on its own so you can fight infections. In autoimmune diseases like lupus, the treatment may help your body raise low red-blood-cell counts.
Why do people take IVIG?
First, IVIg can protect against infections. People who have very low antibody levels in their blood and thus are susceptible to infections have fewer infections if they receive regular infusions of IVIg.
Why do we need antibodies?
It is normal for the immune system to make antibodies to fight bacterial or viral infections. Nearly everyone has a pool of antibodies circulating in their blood ready to go to battle should there be an invasion by an infectious agent. Another name for these antibodies is immunoglobulin, often abbreviated as Ig.
Does lupus lower antibody levels?
Although this situation is unusual in people with lupus, sometimes the powerful immune-suppressing treatments doctors use to control lupus disease activity will lower antibody levels to the point that IVIg supplementation is needed to protect against infection.
Is IVIG treatment expensive?
While this process can occur by itself -- in which case it is known as polymyositis or dermatomyositis -- it is sometimes seen in lupus. IVIg treatment is reserved for very specific situations since it is an expensive and time-consuming treatment.
Can IVIG block platelets?
It turns out that, in these rare situations, IVIg can block the person’s own white blood cells from gobbling up and destroying platelets or red blood cells, which can cause autoimmune thrombocytopenia and autoimmune hemolytic anemia, respectively. IVIg can also favorably affect immune system function.
What is hemolysis in IVIG?
Hemolysis is an adverse effect related to IVIG administration that occurs in approximately 1.6% of patients but is usually neither recognized nor treated because it lacks clinical symptoms. Hemolysis can result in acute renal failure and thrombosis. In 2008, a case series conducted at Ottawa Hospital identified 16 cases of hemolysis among approximately 1,000 patients who received IVIG infusion (resulting in an incidence of 1.6%) ( 88 ). Most cases with hemolysis present no obvious clinical symptoms and are diagnosed with low hemoglobin levels on a blood examination. IVIG infusion-associated hemolysis was observed from 12 h to 10 days after the first infusion of IVIG, with the lowest hemoglobin level occurring between 1 day and 2 weeks after the last IVIG infusion. Hemolysis is a common complication of high-dose IVIG derived from non-group O blood. In a systematic review conducted by Desborough and colleagues, 62 cases of hemolysis were identified, and 97% of those patients had received a high dose of IVIG (at least 2 g/kg). Of those 62 cases, IVIG-induced hemolysis was most common in patients with type A (65%) or AB (26%) blood ( 89 ). Several more recent studies have also verified that administration of a high dose of IVIG is a contributing factor in hemolysis ( 90 – 92 ). This effect may be associated with the presence of A and B isoagglutinin (anti-A and anti-B antibodies) in the IVIG product. A recent cohort study found that the risk of hemolysis was lower when donors with high plasma titers of anti-A antibodies were excluded, especially in patients requiring ≥1.75 g IVIG/kg ( 93 ). Abnormal laboratory tests that may indicate hemolysis include decreased hemoglobin and haptoglobin levels, increased lactate dehydrogenase levels, and increased hemobilirubin and reticulocyte counts ( 94 ). The management plans generally proposed in affected patients aim to slow down the rate of infusion, switch to another IVIG product, or check the blood type for potential indications for hemolysis. Hemolysis is self-limiting in the majority of mild and moderate cases. However, proper blood transfusion is needed in severe cases when a Coombs test or a direct or indirect antiglobulin test is negative ( 89, 95, 96 ).
What are the adverse effects of immunoglobulin?
The observed effects include immediate adverse effects, aseptic meningitis, hemolysis, neutropenia, and electrolyte disturbances.
What is SCIG in medicine?
Performing an early assessment of risk factors, infusing at a slow rate, premedicating, and switching from intravenous immunoglobulin (IVIG) to subcutaneous immunoglobulin (SCIG) can minimize these adverse effects.
What is immunoglobulin used for?
Applications involving immunoglobulin have expanded to include treatment for immunodeficiency diseases, idiopathic thrombocytopenic purpura (ITP), Kawasaki disease, and neurologic disorders (including Guillain–Barre syndrome, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, multiple myositis, multiple sclerosis, and autoimmune encephalitis) ( 2 – 8 ). Although immunoglobulin is well tolerated, adverse effects do occur. The majority of these adverse effects are mild and alleviated after infusion withdrawal, but some rare side effects are serious, including aseptic meningitis, renal impairment, thrombosis, and hemolytic anemia ( 9 ). In this paper, we reviewed the incidence, risk factors, clinical manifestations of and preventive measures for adverse effects related to immunoglobulin. The processes employed to minimize adverse reactions are briefly addressed in Figure 1.
What are the symptoms of immunoglobulin?
Flu-like symptoms are the most frequent adverse effects. These include flushing, nausea, fatigue, fever, chills, malaise, and lethargy. One retrospective study showed that 14 of 16 (87.5%) patients developed flu-like symptoms during immunoglobulin administration ( 16 ). Bichuetti-Silva et al. ( 26) found that flu-like symptoms account for more than 80% of immunoglobulin-induced adverse effects. These symptoms always occur within the first hour of infusion, and some adverse effects (such as fever or fatigue) may also arise within 24 h. The mechanism underlying these symptoms remains unclear, but it may be associated with the presence of cytokines, such as IL-6, TNF-α, prekallikrein activator, and kallikrein, in immunoglobulin products. The solution media and complement activation of an immunoglobulin preparation may also represent causes of these effects ( 27, 28 ). The majority of these symptoms are associated with rapid infusion and develop during the initial period of infusion. Hence, it is recommended that infusion should start at a slow rate for the first 30 min ( 29 ).
How long does a headache last after immunoglobulin infusion?
Headache also has a delayed onset of 6–12 h after an infusion and can last between 24 and 72 h.
Is immunoglobulin used for lupus?
Immunoglobulin preparations have been widely used in a variety of diseases, but controlled studies have not been performed for many diseases, such as myasthenia gravis, some forms of lupus erythematosus, septic syndrome, and polymyositis. The improper usage of immunoglobulin increases the risk of adverse effects to some extent; therefore, further studies are needed to demonstrate the proper indications for the use of immunoglobulin.
What does IVIG mean?
● IVIG – Intravenous immune globulin (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" (immune globulin intravenous).
What is immunoglobulin used for?
Immune globulin derived from the plasma of paid donors is used in the treatment of an array of disorders, including primary and secondary immune deficiency states and a variety of autoimmune and inflammatory disorders.
Introduction
Manufacturing
- Production of IVIg for medical use is strictly regulated to ensure a low risk of pathogen transmission and comparable quality of individual batches. Immunoglobulin concentrations in healthy human sera range from 7 to 12 g/l. Seventy-five percent of these immunoglobulins are class IgG. Modern multistep procedures allow for the purification of up to 4.5 g IgG with more th…
Practical Considerations and Side Effects
- IVIg in the treatment of dermatological conditions is usually administered at a dose of 2 g per kg body weight distributed over 2–5 days every 4 weeks. For comparison, this dose is roughly four times higher than the 0.2–0.8 g per kg body weight used in the setting of substitution therapy. Given the half-life of IgG of approximately 3–4 weeks, application of 2 g/kg body weight IVIg ove…
Mechanism of Action and Clinical Use
- The mechanism of action of IVIg in the treatment of autoimmune diseases is still a matter of debate. Generally speaking, one can discriminate between functions of the Fcγ region and the F(ab)2 region and their effects on a cellular level (Figure 1). These functions are not mutually exclusive, and given the heterogeneity of diseases IVIgs are used t...
Outlook
- IVIg is successfully used to treat an expanding range of autoimmune diseases. While strong evidence points toward a prominent role of the Fcγ fragment to convey the beneficial effects of IVIg treatment, there may be more than one mechanism of action, and their precise role may vary depending on the disease in focus. It is, however, tempting to speculate that only a fraction of th…
Author Contributions
- JH wrote the first draft of the manuscript. JH and AE revised the work for important intellectual content. JH and AE read and approved the submitted version.
Funding
- We acknowledge financial support by Deutsche Forschungsgemeinschaft within the funding programme Open Access Publishing, by the Baden-Württemberg Ministry of Science, Research and the Arts and by Ruprecht-Karls-Universität Heidelberg.
Conflict of Interest Statement
- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.