[PAGID] IVIG and aseptic meningitis

[Berger, Melvin]

I agree with Anita- dividing the dose and giving smaller increments more frequently certainly might help, and sub-cu usually facilitates that.  If that is not feasible, we often try to prophylax delayed migraines with prednisone at the end of the infusion, 24 and 48 hrs later for the next couple of infusions, and/or periactin the morning after the infusion and the next morning. Often after 2 or 3 infusions, or with a different product, severe headaches/migraines remit, but some people continue to have them like clockwork 48-72 hours after the infusion. It has never been clear to me whether post infusion migraine and aseptic meningitis are part of a spectrum or have different pathophysiologies. 
 
Melvin Berger, M.D., Ph.D.
Professor of Pediatrics and Pathology
Case Western Reserve University
phone 216 844 3237
 
Director, Jeffrey Modell Center for Primary Immune Deficiencies
Division of Allergy-Immunology
Rainbow, Babies and Children's Hospital
University Hospitals of Cleveland
RB&C Rm 504, MS 6008B
11100 Euclid Ave.
Cleveland, OH 44106

________________________________

From: pagid-bounces at list.clinimmsoc.org on behalf of Anita Gewurz
Sent: Wed 12/5/2007 12:55 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] IVIG and aseptic meningitis


Chris,


SC gammaglobulin (SCGG) would avoid the problem.  If you have a young child on SCGG who could show your patient how it works, he might be less fearful of it.  Any local discomfort with initial infusions can be minimized with topical lidocaine and lower starting doses.  As Mel Berger and others will tell you, the infusion can be completed while the patient watches a video, does homework or sleeps and can go with him on vacation trips.   Quality-of-life is better for the whole family and so are trough IgGs.

Good luck!

Anita

Anita Gewurz MD <agewurz at rush.edu>
Section of Allergy/Immunology
Department of
Immunology/Microbiology
Rush University Medical Center
1725 W Harrison - 117
Chicago IL 60612
TEL (312) 942-6296 
VM  (312) 942-4912
FAX (312) 563-2201
PAGER/CELL (847) 224-8550




On Dec 5, 2007, at 9:21 AM, Chris Seroogy wrote:


	Dear Colleagues,

	I have a question about management of aseptic meningitis and IVIG.

	We have a 5 y/o with chemotherapy-induced immunodeficiency who meets
	criteria for immunoglobulin replacement.  He just had his first infusion
	(400mg/kg gammagard S/D) which went well, but 48 hours later developed
	severe headache and stiff neck.  I did not evaluate him, but the heme/onc
	colleagues felt he had aseptic meningitis and this resolved with pain
	management.

	My question is what has worked for individuals to prevent/prophylaxis this
	side effect?  He needs the product and I am told subcutaneous is not an
	option since he will pull out the tubing and it would be too much of a time
	commitment for the family.  Thank you for any input!  Regards, Chris







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