[PAGID] IVIG reactions

[Berger, Melvin]

My experience is in accord with Mark's- smaller more frequent infusions usually ameliorate local as well as systemic reactions. Be sure you are putting into a sites with sufficient soft tissue "pinch an inch", and use 11-13 mm needles. A common problem occures when very short needles are used and a significant part of the dose is actually intradfermal  You might also inquire as to whether there are emotional issues surrounding the IgG therapy which are being exprssed as pain.
 
We have occaisionally had patients on IV IgG who actually had severe back spasms causing pain during infusions. Such patients may responfd to prophylaxis/treatment with valium.
 
Melvin Berger, M.D., Ph.D.
Adjunct 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 Marc Riedl
Sent: Thu 1/15/2009 12:04 PM
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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