[CIS PIDD] [cis-pidd] challenging patient for IVIG/SCIG

[John Ziegler]

Dear Elena

Presumably this is a replacement indication. Subcut sounds to be the way to go.

John



Professor John B. Ziegler 
School of Women's & Children's Health, University of NSW 
C/o Department of Immunology & Infectious Diseases 
Sydney Children's Hospital 
High St., Randwick NSW 2031 
Australia 
T: (02) 93821515 
F: + 61 + 2 93821580 
E: j.ziegler at unsw.edu.au 



-----Original Message-----
From: Perez, Elena [mailto:e.perez13 at med.miami.edu] 
Sent: Wednesday, 6 November 2013 4:09 AM
To: CIS-PIDD
Subject: [cis-pidd] challenging patient for IVIG/SCIG

Dear All,

Anyone have strategies beyond the normal premedication and the usual routine, etc for patients who fail multiple IVIG products for signs/sx of anaphylaxis?

The patient is a cardiac transplant patient who is almost 13yo, chronic immunosuppression, very low T cells, normal B cells. Reactions reportedly happen within minutes of infusion, and involve increased heart rate, swelling of face, "glassy eyed" pale, and itchy throat, and feels that she will pass out.

I am seeing her now for the first time, after she has failed at least 5 therapies (adjusting hydrocortisone, solumedrol, antihistamines before and during infusion etc.) under the care of outside immunologist.



She often tolerated 4-5x then with subsequent infusions becomes sick and pale, HR increased,

SC Hizentra -- tolerated for a while then started with signs of allergy.

Gammagard and Hizentra: glazed look, pale, itchy throat, swelling of eye within one two minutes. VSS HR went up a little. She had been on hizentra for a while and reactions kept mounting. Despite benadryl and hct up dosing.

Privigen--pale, lower back pain. Ran over 36hours.



I was thinking to try Octagam (no volume issues), in house OR try small doses of subcutaneous daily.



Appreciate others experience with difficult infusion reactions or patients with allergies to multiple products. In my experience this is very rare.... and usually solved by switching products or usual premeds. She definitely needs the therapy it is just a question of how to give it.



Thanks!

Elena

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