[PAGID] IVIG reactions

[Jack Bleesing]

I think many of us have a patients like this. Seems like a good case to start the new year with a lively discussion.

If he is a card-carrying member of the CVID family with all the associated complications that influence prognosis and life-expectancy, I think there is only one long-term solution: work towards a situation in which IVIG will no longer be required.

Regards,

JB

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Jack J.H. Bleesing, M.D., Ph.D.
Associate Professor of Pediatrics
Cincinnati Children's Hospital Medical Center
Division of Hematology/Oncology
3333 Burnet Avenue, MLC 7015
Cincinnati, OH 45229
513-636-4266 (phone)
513-636-3549 (fax)
Jack.Bleesing at CCHMC.org
http://www.cincinnatichildrens.org/immunodeficiencies/



>>> "Kobrynski, Lisa" <lkobryn at emory.edu> 1/14/2009 10:53 PM >>>

I need some creative suggestions to help me with a 17 yo CVID patient
This patient develops severe lower back pain with IVIG infusions.  The back pain usually starts 2-3 hours into the infusion and is not associated with changes in vital signs.  We have tried 4 different IVIG preparations, 5%, 10% preparations, slowing the rate of infusion (as low as 25 cc/hr), premedication with antihistamine, acetaminophen, ibuprofen, corticosteroids (all together).
We tried SC IG and he complained of severe pain at the sites of infusion despite changes in needle size and product.

He does need some passive immunity, he has lung disease, and IgG is <400 off IVIG.

Any suggestions?

Lisa Kobrynski, MD, MPH
Associate Professor of Pediatrics
Section, Allergy/Immunology

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