- Last Updated on 14 December 2016
Intravenous immunoglobulin, commonly known as IVIG, is an intravenous blood product containing antibodies (a.k.a. immunoglobulin, abbreviated Ig). Antibodies are made by our immune system and their normal function is to bind and inactivate harmful infectious particles such as viruses and bacteria. A batch of IVIG is generated by collecting and concentrating the antibodies present in the blood of thousands of healthy blood donors, and removing other blood constituents (i.e. red blood cells, white blood cells, platelets, etc.) IVIG is most commonly used to treat immune deficiency disorders and autoimmune disorders (a large family of diseases in which a patient's immune system attacks a patient's own body, and more generally, conditions of inappropriate immune response that generate harmful inflammation).
In the treatment of immunodeficiency, IVIG acts as to supplement missing antibodies in a given patient. In the treatment of autoimmune diseases and inflammatory states, the exact mechanism of action of IVIG is not known, but it is thought that IVIG most likely removes harmful antibodies (i.e. donor antibodies attacking harmful antibodies made by the patient's own immune system). To some extent, some forms of epilepsy—especially infantile spasms—are thought to involve inappropriate inflammation in the setting of immune dysregulation. This in part explains why hormonal therapies (prednisolone and ACTH), which suppress the immune system, may be effective in the treatment of infantile spasms. Nevertheless, hormonal therapies likely have actions beyond the scope of immunity and immune regulation.
There are no definitive clinical trials of IVIG in the treatment of infantile spasms, but there are numerous reports of success in the scientific literature and elsewhere. These reports lack appropriate scientific controls (e.g. placebo treatments and "blinding" of patients and investigators). It is not clear that those patients who improved after IVIG therapy actually responded to the the IVIG, or exhibited a response to other treatments administered simultaneously, or simply had a spontaneous resolution of infantile spasms. IVIG is often prescribed when traditional therapeutic options have been exhausted. Given the lack of compelling data supporting the use of IVIG for treatment of infantile spasms, we cannot offer a compelling recommendation for this treatment. The risks, benefits, and costs (approximately $3,000 to $5000 USD per infusion for an infant) should be carefully weighed for each patient.
Although there is no consensus as to the ideal dosage and schedule of IVIG treatment, typical regimens are in the range of 0.4 to 2.0 grams/kg/course, administered over 1 to 5 days. In those cases in which IVIG is thought to be effective, responses are usually observed 1 to 3 weeks after infusion, and repeated infusions may be necessary to maintain the response.
Side Effects / Precautions:
As the name suggests, IVIG is administered intravenously. The first time IVIG is given, the infusion should be delivered in a highly supervised medical setting to monitor for potential side effects and adverse reactions. In many cases, after an initial infusion is well tolerated, subsequent infusions may be given in the home with nurse supervision. Adverse reactions include anaphylaxis (a very dangerous allergic response), kidney injury (acute renal failure), aseptic meningitis (severe headache, neck-stiffness, light/sound hypersensitivity, nausea, vomiting), serum sickness, fever, severe rash, and in very rare cases IVIG has been associated with blood clots and heart attack. Adverse reactions tend to be more frequent among patients who have a relative deficiency of a class of antibodies known as IgA. The frequency of some reactions may be reduced by using IgA-depleted formulations of IVIG. Approximately 30 to 60 minutes before infusions, it is typical to "premedicate" patients with acetominophen (Tylenol®), diphenhydramine (Benadryl®), and/or intravenous steroids in an effort to reduce the likelihood of these immunologic/inflammatory reactions.
Significant precautions are taken in the manufacturing of IVIG, but it is nevertheless a blood product, and carries a very small risk of communicable blood-borne infections such as hepatits C, HIV, etc.
Vaccinations should not be administered during or within several weeks of a course of IVIG, as the treatment may impair the normal production of antibodies necessary for a vaccine to work. For additional information, refer to our vaccine page.
This medication should be administered only under the direct supervision of a physician.