Immediate adverse reactions to intravenous immunoglobulin in primary immune deficiencies: a single center experience

Background and objective. Adverse reactions related to intravenous immunoglobulin (IVIG) infusions vary from 1 to 81%, with an average of 20%. They may be classified as immediate; occurring during the infusion itself or delayed; occurring after the infusion has been ceased. In the present study, we aimed to evaluate the frequency of immediate adverse reactions due to IVIG infusions in primary immune deficiency (PID) patients. Methods. The study population was composed of 109 patients. A total of 763 infusions were recorded for demographic data and adverse reactions. Results. The participants included 32 girls (29%) and 77 boys (71%). The mean age was 11.8 ± 5.7 years (0.6-33.5 years). Early adverse events (AE) were recorded in 34 (4.5%) among 763 IVIG infusions including 30 mild (88.2%), 3 moderate (8.8%) and 1 severe (2.9%). The most common immediate adverse reactions were fever (29.4%) and headache (29.4%). The risk of AE was higher among primary antibody deficiency (PAD), compared to combined immunodeficiency (OR 2.61, 95%CI 1.061-6.475; p = 0.037). Conclusions. Use of various intravenous immunoglobulin treatments should be considered with regard to side effect profiles observed. In our cohort, PID patient experienced mostly mild AE; PAD was associated with an increased risk of AE.

___

1. Schwartz SA. Intravenous immunoglobulin treatment of immunodeficiency disorders. Pediatr Clin North Am 2000; 47: 1355-1369.

2. Aghamohammadi A, Moin M, Farhoudi A, et al. Efficacy of intravenous immunoglobulin on the prevention of pneumonia in patients with agammaglobulinemia. FEMS Immunol Med Microbiol 2004; 40: 113-118.

3. Quartier P, Debre M, De Blic J, et al. Early and prolonged intravenous immunoglobulin replacement therapy in childhood agammaglobulinemia: a retrospective survey of 31 patients. J Pediatr 1999; 134: 589-596.

4. Busse PJ, Razvi S, Cunningham-Rundles C. Efficacy of intravenous immunoglobulin in the prevention of pneumonia in patients with common variable immunodeficiency. J Allergy Clin Immunol 2002; 109: 1001-1004.

5. Bayrakci B, Ersoy F, Sanal O, Kiliç S, Metin A, Tezcan I. The efficacy of immunoglobulin replacement therapy in the long-term follow-up of the B-cell deficiencies (XLA, HIM, CVID). Turk J Pediatr 2005; 47: 239-246.

6. Baris S, Ercan H, Cagan HH, et al. Efficacy of intravenous immunoglobulin treatment in children with common variable immunodeficiency. J Investig Allergol Clin Immunol 2011; 21: 514-521.

7. Laguna P, Golebiowski-Staroszcyk S, Trzaska M, Grabarcyzk M, Matysiak M. Immunoglobulins and their use in children. Adv Clin Exp Med 2015; 24: 153-159.

8. Pierce R, Jain N. Risks associated with the use of intravenous immunoglobulin. Transfus Med Rev 2003; 17: 241-251.

9. Zülfikar B, Koç B. Use of intravenous immunoglobulin in pediatric practice. Turk Pediatri Ars 2014; 49: 282-288.

10. Katz U, Achiron A, Sherer Y, Shonenfeld Y. Safety of intravenous immunoglobulin (IVIG) therapy. Autoimmun Rev 2007; 6: 257-259.

11. Benesch M, Kerbl R, Lackner H, et al. Low-dose versus high-dose immunoglobulin for primary treatment of acute immune thrombocytopenic purpura in children: results of a prospective, randomized single-center trial. J Pediatr Hematol Oncol 2003; 25: 797-800.

12. Duhem C, Dicato MA, Ries F. Side-effects of intravenous immune globulins. Clin Exp Immunol 1994; 97(Suppl 1): 79-83.

13. Lemm G. Composition and properties of IVIG preparations that affect tolerability and therapeutic efficacy. Neurology 2002; 59(12 Suppl 6): S28-S32.

14. Bichuetti-Silva D, Furlan FP, Nobre FA, et al. Immediate infusion-related adverse reactions to intravenous immunoglobulin in a prospective cohort of 1765 infusions. Int Immunopharmacol 2014; 23: 442-446.

15. Berger M. Principles of and advances in immunoglobulin replacement therapy for primary immunodeficiency. Immunol Allergy Clin North Am 2008; 28: 413-437.

16. Diagnostic criteria for PID. Available at: https:// esid.org/Working-Parties/Registry-Working-Party (Accessed on 6th February 2019).

17. Picard C, Al-Herz W, Bousfiha A, et al. Primary immunodeficiency diseases: an update on the classification from the International Union of Immunological Societies Expert Committee for primary immunodeficiency 2015. J Clin Immunol 2015; 35: 696-726.

18. Bousfiha A, Jeddane L, Picard C, et al. The 2017 IUIS phenotypic classification for primary immunodeficiency. J Clin Immunol 2018; 38: 129- 143.

19. Galli E, Barbieri C, Cantani A, Solana A, Longhi MA, Businco L. Treatment with gammaglobulin preparation for intravenous use in children with humoral immunodeficiency: clinical and immunologic follow-up. Ann Allergy 1990; 64(2 Pt 1): 147-150.
Turkish Journal of Pediatrics-Cover
  • ISSN: 0041-4301
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 1958
  • Yayıncı: Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü
Sayıdaki Diğer Makaleler

Role of kallistatin in pediatric patients with pulmonary arterial hypertension

Özge PAMUKÇU, Derya AY, Kazım ÜZÜM, Didem BARLAK KETİ, Mehmet KÖSE, Ali BAYKAN, Süleyman SUNKAK, Nazmi NARİN

Retrospective evaluation of childhood paraphenylenediamine intoxication due to black henna

Elif GÜDELOĞLU, Barış ERDUR

Corneal endothelial morphology and anterior segment parameters in children with type 1 diabetes mellitus

Alper BAYAT, Şeyma ÖZTURAN, Akin CAKİR, Selim BÖLÜKBASİ, Burak ERDEN, Diğdem BEZEN, Mustafa ELCİOĞLU

New guidelines for diagnosis of rheumatic fever; do they apply to all populations?

Pakinam Abdel Aty MARZOUK, Hala HAMZA, Naglaa MOSAAD, Soha EMAM, Aya M. FATTOUH, Lamiaa HAMİD

A new location for pediatric immunoglobulin G4 related disease: the biceps muscle

Semanur ÖZDAL, Mesiha EKİM, Gülşah KAYGUSUZ, Elif ÇELİKEL, Göksel VATANSEVER, Nurdan TAÇYILDIZ

Effect of gestational diabetes on the vitamin D levels in the neonates: a case control study

Arathy VIJAY, Smriti SINHA, Seema Pavaman SINDGIKAR, Vijaya D. SHENOY

Low function of natural killer cells in treated classic Menkes disease

Jayalakshmi Narayan BHAT, Paul MAERTENS

Pyloroduodenal intussusception due to diffuse juvenile polyposis in a 3 year-old child: case report

TUTKU SOYER, Bilge GÖRDÜ, Özlem BOYBEYİ TÜRER, Berna OĞUZ

Congenital myotonia: a review of twenty cases and a new splice-site mutation in the CLCN1 gene

Nezir ÖZGÜN, Hasan TAŞLIDERE

Emotional support for parents with premature children admitted to a neonatal intensive care unit: a qualitative phenomenological study

Sabiniana San Rafael GUTIERREZ, Purificaci n Escobar GARCIA, Alicia Saelices PRELLEZO, Laura Rodriguez PAULI, Beatriz Longueira del CASTİLLO, Rafaela Blanco SANCHEZ