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

[Daniel Suez]

I would check for anti IgA antibodies and will try to use Gammagard S/D
Low IgA product.
Dan


Allergy, Asthma & Immunology Clinic PA

Daniel Suez, MD
Board Certified in Allergy & Immunology and
Diagnostic Laboratory Immunology
Clinical Associate Professor
UT Southwestern Medical School at Dallas
Allergy & Immunology Division
1115 Kinwest Pkwy, Suite 100
Irving TX 75063
T: 972-401-0545  C: 214-708-0727




On 11/5/13 11:09 AM, "Perez, Elena" <e.perez13 at med.miami.edu> wrote:


>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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