[PAGID] IVIG reactions

[Kirkpatrick, Charles]

In my clinic, patients with these symptoms usually tolerate SQ IgG very well and without symptoms.
The 10% solutions usually work without adverse events.
We have had less success with 15% Vivaglobin.  Some patients have site reactions that are severe enough that they do not want to continue SQ treatments.  They almost always do better if they use 15% IgG.  We use Gamunex

Charles Kirkpatrick, M.D.
Univ of Colorado Health Science Center

-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Marc Riedl
Sent: Thursday, January 15, 2009 10:05 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] IVIG reactions

For patients with persistent intolerable discomfort at SCIG sites, we've been successful with either different product (Gamunex most often tolerated), topical anesthetic, and/or more frequent administration to reduce volume (3x/weekly or daily).

Marc Riedl, M.D., M.S.
Assistant Professor of Medicine
Section Head, Clinical Immunology and Allergy
UCLA - David Geffen School of Medicine



From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Belohradsky, Bernd Prof. Dr.
Sent: Thursday, January 15, 2009 12:55 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] IVIG reactions

if he complains about severe local pain under scIgG he might seriously have a psychosomatic problem; in more than 100 patients, children and adults, we have never seen this problem ! did you try local anesthetic ointment ?
(Bernd H.Belohradsky,MD,Munich)

________________________________
Von: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] Im Auftrag von Kobrynski, Lisa
Gesendet: Donnerstag, 15. Januar 2009 04:53
An: pagid at list.clinimmsoc.org
Betreff: [PAGID] IVIG reactions
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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