Medications

Intravenous Immune Globulin (IVIG)

Intravenous Immune Globulin (IVIG) is a blood product used to treat autoimmune conditions including diseases that cause inflammation of the blood vessels (vasculitis), lupus, and myositis.

IVIG was first developed in the 1950s and first used to treat autoimmune diseases in the 1980s.

Taking Intravenous Immune Globulin (IVIG)

IVIG is given by an intravenous infusion by a trained nurse. Each infusion can take from 2 to 6 hours. How often IVIG infusions are given will be determined by your doctor.

Although some patients can feel better quite quickly after receiving treatment, in others it can take a little longer.

Important Tests and Risks

Blood Test for Antibody Levels

Patients should have a blood test before starting IVIG to check that their antibody levels (IgA) are not low.

Regular Blood Tests

Patients being treated with IVIG should also have regular blood tests to check blood counts, and ensure kidney and liver health.

Risk of Infection

IVIG is a human blood product and so involves a very small risk of getting an infection.

Patients should call their doctor if they develop a fever after receiving treatment.

People donating IVIG are carefully screened to lower the risk of infection, and the purification process used to manufacture IVIG eliminates bacteria and inactivates most viruses.

Science

How IVIG Works

Blood is a mixture of plasma, red and white blood cells, platelets, and antibodies. Immunoglobulin(Ig) refers to the portion of blood plasma that contains antibodies.

Immunoglobulins (antibodies) are manufactured by B-cells, a type of white blood cell that is part of the body’s immune system. Immunoglobulins play an essential role in defending the body against bacterial and viral infections.

In patients with an autoimmune disease, their immune system becomes confused and starts attacking the body’s own tissue. The mistaken immune response can lead to the creation of antibodies that target the body’s own tissue, called autoantibodies. Autoimmune diseases like lupus, myositis, and types of vasculitis are caused by the work of autoantibodies.

Supplementing the blood with immunoglobulins from multiple donors has a variety of effects, including immunomodulation (modulation, or control, of the immune system; it adjusts the level of immune response). There are a number of reasons why this happens, and not all of them are fully understood.

In patients with autoimmune disease, the result of the immunomodulation effect is a significantly reduced attack on the body by the patient’s own autoantibodies, and this results in a reduction of symptoms.

IVIG can also help boost a weakened immune system. Injecting antibodies from many different donors helps the recipient’s immune system recognize and respond to attacks by harmful bacteria and viruses. This boost can help offset the increased risk of infection seen in patients whose immune systems are weakened because of genetic abnormalities, disease, or by medication.

Safety

Side Effects

IVIG is usually well tolerated by patients. People receiving this treatment should talk to their doctor if they are concerned about any side effects.

Possible side effects include:

  • Infusion reaction – IVIG can rarely cause an allergic reaction during the infusion. Doctors often give patients Tylenol & Benadryl before infusions to reduce the risk of a reaction.
  • Shortness of breath – Some patients can experience shortness of breath or chest discomfort with IVIG. This is due to fluid build up. Patients should tell their if this happens.
  • High blood pressure – IVIG can cause an increase in blood pressure. Doctors will monitor this. Patients should tell their if they have high blood pressure.
  • Headache – Headache is one of the more common side effects to IVIG. Most headaches go away after 24-48 hours. IVIG can induce migraine headaches. It can rarely irritate the lining of the brain (meningitis).
  • Fever & flu-like symptoms – When receiving IVIG, some patients have developed a fever and flu-like symptoms including “feeling out of sorts”, chills, fatigue, and weakness.
  • Blood clots & vascular disease – IVIG has rarely been associated with an increased risk of blood clots. Other vascular problems such as strokes & heart attacks have been reported in patients receiving high doses of IVIG.
  • Skin rash – IVIG can rarely cause a skin rash.
  • Kidneys – IVIG has been linked to sudden kidney failure when IVIG is given in a sugar (sucrose) mix. Most IVIG used today does not contain sucrose.

Who Should NOT Take IVIG

Patients who should NOT be receiving IVIG treatment include:

  • Anyone who has had a previous serious allergic reaction to IVIG.

When to Call a Doctor

People who receive IVIG treatments should call a doctor if they feel sick and want to stop, or if they are concerned about any side effects.

Patients who feel sick after receiving an infusion should contact their doctor. Other reasons to call a doctor while receiving IVIG treatment include:

  • Fever or possible infection
  • Severe headache
  • Shortness of breath or chest pain
  • Develop a rash
  • Develop new swelling in a leg or arm

Video

Watch Dr. Andy Thompson, a Canadian rheumatologist, introduce Intravenous Immune Globulin (IVIG) in this short video: