[PAGID] IVIG reactions

[Soheil Chegini]

I had a patient who had significant local discomfort with SCIg (Vivaglobin).  It resolved after I switched him over to Gammastan and slowed down the rate.  My next consideration would have been pre-injection of the site with hyaluronidase to loosen up the subcutaneous soft tissue or a long-acting local anesthetic such as bupivacaine.
 
Best,
Soheil
 
Soheil Chegini, MD
Assistant Professor of Medicine & Pediatrics
Penn State Hershey Medical Center
500 University Dr. H041
Hershey, PA 17033
Tel. 717-531-6525
Fax 717-531-5785



>>> "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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