Intravenous immunoglobulin treatment in the primary immunodeficiency diseases

In the past decade, the development of intravenous immunoglobulins has altered the therapeutic goals of clinical immunologists caring for patients with primary humoral immunodeficiency disease. In the years prior to immunoglobulin prophylaxis, patients with severe defects died of sepsis or other overwhelming infection. The introduction of intramuscular immunoglobulin has permitted these patients to live longer and to suffer fewer infections. However, the therapeutic dose of intramuscular immunoglobulin was dictated more by the amount of the solution that could be introduced into a muscular area than by considerations of maximum efficacy. This factor is not important to the intravenous administration of immunoglobulin. In the past 6 years, therapeutic trials comparing intramuscular immunoglobulins with newly developed intravenous immunoglobulins have demonstrated the efficacy of these preparations in terms of reduced rates of infection and reduced use of antibiotics. The infusion of these products is accompanied by a low but continued rate of adverse reactions, most of which occur for unclear reasons. A small number of these reactions are due to the presence of pre-existing anti-IgA antibodies. For such patients, a product low in IgA may be useful.