[PAGID] IVIG and aseptic meningitis

[Lisa Kobrynski, MD, MPH]

We have used all the afore mentioned strategies for dealing with the headaches.
Somethings seem to work better than others.  We have used 1 or 2 doses of
Decadron 12-48 hours post infusion and that seems to work for the majority of
patients.  

It seems as if we all have multiple patients who experience post-infusion
headache and have tried a variety of therapies for this.  I don't know if this
is a true epi-phenomenon or not, but it does seem to be a more frequent problem
in our clinic than 10 years ago.  Does anyone else have that impression?  Is
there any data on frequency/prevalence of this side effect and the effect of
various therapies?  If not, it might be helpful for the community at large to
put together a description of our collective experience. 

Just a thought.

Lisa

Lisa Kobrynski, MD, MPH
Assistant Professor of Pediatrics
Division of Allergy and Immunology
Emory University
404-727-3575
404-727-5045 (fax) 

Quoting "Berger, Melvin" <Melvin.Berger at UHhospitals.org>:


> 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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