[PAGID] IVIG and endogenous antibody production

[Riedl, Marc]

Jason,

Regarding Point #2 below, there is a 2006 CDC statement addressing this question.  The full document can be found at:  http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5515a1.htm

I don't have the primary literature references for the statement, but the main points are:
1) IgG products have been shown to substantially neutralize live antigens in current measles (MMR) and varicella vaccine formulations. Efficacy may be affected for several months after IgG products are given (timing varies depending on dose and product - summarized in Table 4 of the document).
2) Typhoid, yellow fever, influenza live vaccines don't appear to be affected by IgG dosing as U.S.-sourced plasma doesn't contain significant levels of specific antibodies to these agents.  Little concern for neutralization of these antigens.
3) Current data shows non-live vaccine antigens have much less interaction with IgG antibody products and appear to maintain immunogenicity so no need to alter dosing schedule.
4) Obvious caveat that we don't give live vaccines to our immunodeficient patients but certainly patients getting IVIG for other indications might benefit from these.

Best regards,

Marc

Marc Riedl, M.D., M.S.
Assistant Professor of Medicine
Section Head, Clinical Immunology and Allergy UCLA - David Geffen School of Medicine
10833 Le Conte Ave, 37-131 CHS
Los Angeles, CA  90095-1680
Tel 310.206.4345  Fax 310.267.0090

-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of raas0027 at umn.edu
Sent: Tuesday, April 27, 2010 2:19 PM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] IVIG and endogenous antibody production

Hello everyone,

I am struggling to find data or literature (e.g. through OVID, PubMed)
supporting the following statements that I find repeatedly in
textbooks/journal review articles:


1. administration of passive antibodies [e.g. IVIG] to antigens that a
patient has not previously encountered can suppress his or her endogenous
capacity to produce antibodies


or in numerous patient-oriented websites:


2. '...If your child is receiving IVIG, there is a risk that it may
interfere with the effectiveness of certain vaccines, even causing the
vaccine to fail.'


Although these seem plausible, are any of you aware of published studies
that demonstrate this with IVIG? I would love to read them.

I would also be interested in anecdotal comments.


Thanks,

Jason

--
Jason Raasch, MD

Midwest Immunology Clinic
15700 37th Ave N
Suite 110
Plymouth, MN 55446

(Phone) 763.577.0008
(FAX)   763.5770192

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