Slow subcutaneous human intravenous immunoglobulin in the treatment of antibody immunodeficiency: Use of an old method with a new product☆,☆☆,★
Section snippets
Methods
The subcutaneous infusions were usually given weekly or biweekly by using a battery-operated pump and a 20 ml syringe connected to a 1 cm × 24-gauge needle (Sof-Set; Minimed Technologies, Sylmar, Calif.) that is fitted with a stylus and is inserted perpendicularly into the subcutaneous tissue. The usual site was the abdominal wall 2 inches from the umbilicus in any direction (rotated 90° at each visit), and the rate is adjusted to complete the infusion in 3 hours. The inner thigh or arm can
Results
Four patients (numbers 1, 2, 4, and 8; Table I) were given subcutaneous IVIG because of poor venous access. One of these patients had stopped IVIG because of this problem. Nursing personnel find this route easier, with less risk of needle-stick injury.
Two patients (numbers 3 and 7) were given IVIG subcutaneously because of prior anaphylactic reactions to IVIG. One of these patients had repeated severe anaphylactic reactions but was able to tolerate subcutaneous infusions with the simultaneous
Discussion
The successful use of the subcutaneous route for administration of IVIG in these eight patients parallels the safety and efficacy reported by European physicians in immunodeficient subjects.2, 3, 4 Intramuscular immunoglobulin for intramuscular use (16.5%) is in short supply in the United States, and it contains thimerosol, a mercury preservative. Accordingly, we have used preservative-free IVIG by clysis with minimal local or systemic effects. Three different brands of 10% IVIG were used
References (5)
- et al.
High-dose immunoglobulin replacement therapy by slow subcutaneous infusion during pregnancy
JAMA
(1982) - et al.
Home treatment of hypogammaglobulinaemia with subcutaneous gammaglobulin by rapid infusion
Lancet
(1991)
Cited by (41)
Guidelines for the use of human immunoglobulin therapy in patients with primary immunodeficiencies in Latin America
2014, Allergologia et ImmunopathologiaPharmacokinetics of subcutaneous immunoglobulin and their use in dosing of replacement therapy in patients with primary immunodeficiencies
2011, Clinical ImmunologyCitation Excerpt :Intravenous IgG administration usually requires a trained professional in an office or hospital setting, may be associated with severe systemic side effects, and may be difficult in patients who lack good venous access [1,5,6]. Subcutaneous IgG (SCIG) infusions were first used mainly for patients who did not tolerate IgG by intramuscular or IV routes [6–9], but their use has increased recently because they have fewer systemic side effects and do not require venous access [7]. Subcutaneous IgG can be self-infused where and when it is most convenient for the patient or parent, without the assistance of trained professionals.
PASSIVE IMMUNIZATION
2009, Feigin and Cherry's Textbook of Pediatric Infectious Diseases, Sixth EditionPreparation and use of therapeutic antibodies primarily of human origin
2008, BiologicalsCitation Excerpt :A recently licensed preservative-free 16% product (Viviglobulin-ZLB) was licensed in 2006 in the USA for subcutaneous use [70,71]. However, 10–12% solutions for IGIV can also be used safely [55]. These products are usually infused into the abdominal wall or thigh with a battery-operated portable infusion pump [68,70].
Subcutaneous Administration of IgG
2008, Immunology and Allergy Clinics of North AmericaSelf-infusion Programmes for Immunoglobulin Replacement at Home: Feasibility, Safety and Efficacy
2008, Immunology and Allergy Clinics of North America
- ☆
From the Departments of aPediatrics and bMedicine, UCLA School of Medicine, Los Angeles; cAllergy, Asthma, and Immunology Associates, Omaha; dthe Department of Pediatrics, New Jersey Medical School, Newark; eJonathon Jacques Cancer Center, Long Beach; and fKelsey Seybold Clinic, Houston.
- ☆☆
Reprint requests: E. Richard Stiehm, MD, UCLA Children's Hospital, 22-387 MDCC, 10833 Le Conte Avenue, Los Angeles, CA 90095-1752.
- ★
1/1/89531