[CIS PIDD] [cis-pidd] Rash with IVIG and SCIG

[Richard Wasserman]

Obviously, the problem is either related to the IgG or an excipient. The
three products in the US for SC have very little other than glycine or
proline. If the products you have tried are similar, I would try doing
something like desensitization. It would be inconvenient to do it IV but I
am concerned about problems doing it SC. The starting point is arbitrary
and one hates to waste IgG but you might start with something between 1 and
100mg per day five days a week. If there are excipients, try a different
product.
Richard Wasserman
Dallas

On Thu, Aug 27, 2015 at 7:28 PM, Miriam Hurst (ADHB) <MHurst at adhb.govt.nz>
wrote:

> Hi all,
>
>
>
> I was wondering if anyone had any experience of managing a patient with an
> eczematous reaction initially to SCIG, now recurring with IVIG. He is a 39
> year old male with CVID and bronchiectasis, on IVIG 33g monthly but had
> significant problems with headache for 12-24 hours post infusion despite
> premed. He was on this for about 6 years despite these symptoms (at a
> peripheral hospital) and then earlier this year after review was switched
> to SCIG. Some days after the first dose he began developing a rash
> initially around the injection sites but spreading to involve his entire
> body, esp palms/soles of feet – photo attached.
>
>
>
> Skin biopsy was reported as consistent with subacute spongiotic eczema but
> with extravasated red cells and interface activity supporting possible drug
> reaction. He was taken off his SCIG and treated with prednisone, with
> complete resolution of his rash. After reviewing the literature we trialled
> an alternative IVIG product with premed (including 10mg prednisone), but
> the rash recurred 2 days later.
>
>
>
> He is also significantly lymphopenic (0.45 x 10^9/L) with CD4 130, which
> seems to have happened over the same time period as the rash but preceding
> the prednisone use.
>
>
>
> We do have an alternative SCIG product available but I am concerned the
> rash will recur with this as well. Does anyone have any advice on possible
> management approaches?
>
>
>
> Thanks very much,
>
>
>
> Miriam
>
>
>
>
>
> *Miriam Hurst, MBChB, FRACP, FRCPA*
>
> *Clinical Immunologist/Immunopathologist*
>
>
>
> *Clinical Immunology*
>
> *Auckland Hospital*
>
> *Auckland*
>
> *New Zealand*
>
>
>
> *phone: +64 9 307 4949 <%2B64%C2%A09%20307%204949>*
>
> *fax:      +64 9 3074940 <%2B64%C2%A09%203074940>*
>
> *email: **mhurst at adhb.govt.nz* <mhurst at adhb.govt.nz>
>
>
>
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-- 
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
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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