Slow subcutaneous human intravenous immunoglobulin in the treatment of antibody immunodeficiency: Use of an old method with a new product,☆☆,

This work was presented at the American Pediatric Society/Society of Pediatric Research meeting in May 1997.
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Abstract

J Allergy Clin Immunol 1998;101:848-9.

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

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  • A Gardulf et al.

    Home treatment of hypogammaglobulinaemia with subcutaneous gammaglobulin by rapid infusion

    Lancet

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There are more references available in the full text version of this article.

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    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.

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    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].

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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.

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Reprint requests: E. Richard Stiehm, MD, UCLA Children's Hospital, 22-387 MDCC, 10833 Le Conte Avenue, Los Angeles, CA 90095-1752.

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