[CIS PIDD] [cis-pidd] reactions to SCIG

Richard Wasserman drrichwasserman at gmail.com
Sat Jun 21 08:09:30 EDT 2014


Colleagues,

I am posting this patient for a colleague.

She is a 49 yo with a history of sinopulmonary infections but no evidence
of bronchiectasis. Her IgG ranges from 250 to 350/dL, her IgM is normal her
IgA is in the 40s. She has never been treated with IGIV products.



She tolerated the first Hyzentra infusion without a problem and the second
one (given three weeks later) was completed but she then developed itching,
tongue swelling and wheezing 4 hours after the completion of the infusion.
She was treated in the emergency department but did not receive epinephrine.



Prior to the second infusion ACE inhibitor treatment was begun. She had
similar reactions around that time to inactivated influenza vaccine and an
antibiotic. The ACE inhibitor was discontinued.



A few weeks later, she was treated with Gamunex-C (15g subq). Again, there
were no problems during the infusion but she developed itching, wheezing
and tongue swelling several hours later.



Several weeks later she was given 1g of Gammagard subq and within minutes
she developed generalized and tongue pruritis and wheezing.



Another Gammagard subq infusion was attempted. Her PFTs were normal before
the infusion began.  Her FVC was actually 77%, but her FEV1 was 85% and
FEF25-75 was 116%.  Her chest was clear and she did not get a
bronchodilator treatment before the infusion began.  She received no
pre-meds before the infusion was started. The plan was to give her 5 grams
of Gammagard.  After 2 grams, she developed itching of the mouth and end
expiratory wheeze.  The infusion was stopped and she felt a bit better
after 60 minutes so the infusion was restarted. Wheezing worsened as did
the itching.  At that time a serum tryptase was drawn which came back as 2.
 When she was clearly wheezing, there was no change in her PFTs.


Suggestions for a way to treat her?


Thanks,

Richard Wasserman

Dallas

-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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