[PAGID] SQ gammaglobulin reaction

[Ricardo Sorensen]

Hi, We have never observed a similar reaction in children. However, over the
years we have observed a good number of unusual reactions apparently related
to the use of IgIV. In each case, it was important to define exactly the
underlying disease, the dose of IgG per kilo, infusion rates, the brand name
(and sometimes the lot number) and also the premedication used. This is
essential to if a given reaction may be related to any of the factors listed
above.


Ricardo Sorensen  

> From: Rathkopf Melinda M Maj 759 MDOS/MMIA <Melinda.Rathkopf at LACKLAND.AF.MIL>
> Date: Mon, 11 Jul 2005 10:27:52 -0500
> To: "'Christine Seroogy'" <cmseroogy at wisc.edu>, pagid at clinimmsoc.org
> Subject: RE: [PAGID] SQ gammaglobulin reaction
> 
> We are not using SQ Ig here, but one of our neurologist who is using IVIG
> sent us this case:
> 
> "Have you heard of any dermatologic skin reactions to IVIG?  I have a
> gentleman that developed a mild skin rash on his palms following his first
> IVIG course (for neuropathy) at BAMC in March.  The rash persisted, but
> never got any worse.  In May, he got a 2nd IVIG course, and the rash surged.
> Its a distal, exfoliative rash involving his palms, and recently became
> noticable on the soles of his feet.  BAMC dermatologists apparently thought
> this was a "delayed IVIG reaction", and their allergists agreed (albeit
> reluctantly).  
> 
> He's now >6wks out from his last IVIG use, and the rash is still there (if
> not worse).  Ever heard of this before?  I'm going to send him to our
> dermatologists for a 2nd opinion, but I thought I'd ask your advice also.
> Thanks for your help!"
> 
> 
> Any comments or suggestions?
> 
> Thanks,
> 
> Melinda M. Rathkopf, MD
> Wilford Hall Medical Center
> 
> 
> -----Original Message-----
> From: pagid-bounces at clinimmsoc.org [mailto:pagid-bounces at clinimmsoc.org] On
> Behalf Of Christine Seroogy
> Sent: Friday, June 24, 2005 8:09 AM
> To: pagid at clinimmsoc.org
> Subject: [PAGID] SQ gammaglobulin reaction
> 
> Colleagues,
> 
> A 5y/o male patient of ours has been on sq gammaglobulin (16% Baygam)
> for about one year without difficulty.  During his last infusion,
> within 30 minutes he developed a disseminated papular rash.  He was
> seen in his local ED and given benadryl.  There were no other signs or
> symptoms.  Over the next day, the rash covered 100% of his body (palms
> and soles) and has slowly been regressing.  One week later, the papular
> rash covers 5% of his body but he has developed large (10cm)
> desquamating coalescent lesion on his buttock and smaller lesions
> around is mouth (by report he did have some sores in his mouth
> transiently, no eye involvement).  Has anyone seen this?  It is hard
> for me to dismiss the temporal relationship between rash and infusion.
> Thank you for any comments, Chris
> 
> 
> Chris Seroogy, M.D.
> Assistant Professor
> Dept. of Pediatrics
> Mail:  H4/474 CSC, Mailstop 4108
> Shipping:  H4/431 CSC, Mailstop 4108
> 600 Highland Ave.
> Madison, WI  53792
> phone: 608- 263-2652
> fax: 608-265-0164
> 
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