Complications of intravenous immune globulin treatment in neurologic disease

Intravenous immune globulin (IVIg) is advocated as a safe treatment for immune-mediated neurologic disease. We reviewed the medical records of 88 patients who were given IVIg for a neurologic illness. Major complications in four patients (4.5%) included congestive heart failure in a patient with polymyositis, hypotension after a recent myocardial infarction, deep venous thrombosis in a bed-bound patient, and acute renal failure with diabetic nephropathy. Other adverse effects included vasomotor symptoms 26, headache 23, rash 5, leukopenia 4, fever 3, neutropenia 1, proteinuria (1.9 g/day) 1, viral syndrome 1, dyspnea 1, and pruritis 1. Fifty-two patients (59%) had some adverse effect of IVIg infusion, most commonly vasomotor symptoms, headaches, fever, or shortness of breath in 40 (45%), which improved with reduced infusion rate or symptomatic medications. Five (6%) had asymptomatic laboratory abnormalities and seven (8%) had other minor adverse effects. Adverse effects led to discontinuation of therapy in 16% and permanent termination of therapy in 10% of patients. There was no mortality or long-term morbidity. Although adverse effects were frequent, serious complications were rare except in patients with heart disease, renal insufficiency, and bed-bound state. NEUROLOGY 1996;47: 674-677

[1]  Bethany J Figg,et al.  National Institute of Child Health and Human Development , 2013 .

[2]  W. Pettinger,et al.  Autonomic ganglionitis with severe hypertension, migraine, and episodic but fatal hypotension , 1996, Neurology.

[3]  Adams Ew A brief history of the School of Veterinary Medicine at Tuskegee University. , 1996 .

[4]  T. Bertorini,et al.  Complications of intravenous gammaglobulin in neuromuscular and other diseases , 1996, Muscle & nerve.

[5]  R. Lisak Arthritis associated with circulating immune complexes following administration of intravenous immunoglobulin therapy in a patient with chronic inflammatory demyelinating polyneuropathy , 1996, Journal of the Neurological Sciences.

[6]  M. Levitt,et al.  A Comparison of Symptoms after the Consumption of Milk or Lactose-Hydrolyzed Milk by People with Self-Reported Severe Lactose Intolerance , 1995 .

[7]  J. Pérez-Oteyza,et al.  Hepatitis C and immune globulin. , 1995, New England Journal of Medicine.

[8]  S. Frøland,et al.  Hepatitis C infection in patients with primary hypogammaglobulinemia after treatment with contaminated immune globulin. , 1994, The New England journal of medicine.

[9]  W. Litchy,et al.  A plasma exchange versus immune globulin infusion trial in chronic inflammatory demyelinating polyradiculoneuropathy , 1994, Annals of neurology.

[10]  J. Kissel,et al.  Treatment of stiff‐man syndrome with intravenous immunoglobulin , 1994, Neurology.

[11]  M. Dalakas,et al.  Aseptic Meningitis Associated with High-Dose Intravenous Immunoglobulin Therapy: Frequency and Risk Factors , 1994, Annals of Internal Medicine.

[12]  R. T. Lie,et al.  A Population-Based Study of the Risk of Recurrence of Birth Defects , 1994 .

[13]  D. Fish,et al.  Medical treatment of Rasmussen's syndrome (chronic encephalitis and epilepsy) , 1994, Neurology.

[14]  R. Griggs,et al.  Plasma exchange and intravenous immunoglobulin treatment of neuromuscular disease , 1994, Annals of neurology.

[15]  M. Gheorghiade,et al.  WITHDRAWAL OF DIGOXIN FROM PATIENTS WITH CHRONIC HEART FAILURE TREATED WITH ANGIOTENSIN CONVERTING ENZYME INHIBITORS , 2010 .

[16]  S. Misbah,et al.  Adverse Effects of Intravenous Immunoglobulin , 1993, Drug safety.

[17]  M. Dalakas,et al.  Treatment of inclusion‐body myositis with high‐dose intravenous immunoglobulin , 1993, Neurology.

[18]  Robert G. Miller,et al.  Multifocal motor neuropathy: Response to human immune globulin , 1993 .

[19]  J. Mendell,et al.  Acute renal failure resulting from intravenous immunoglobulin therapy. , 1993, Archives of neurology.

[20]  M. Ballow,et al.  Safety of intravenous immunoglobulin. , 1993, Archives of neurology.

[21]  P. Brock,et al.  Aseptic meningitis associated with high dose intravenous immunoglobulin therapy. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[22]  F. Van de Werf,et al.  The risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), and The International Study Group. , 1992, The New England journal of medicine.

[23]  S. Linder Nobel seminar: Molecular medicine — cell biology in disease Cancer and HIV: from viral genes to therapy? , 1992, Journal of internal medicine.

[24]  D. Fulton,et al.  Immune hemolysis, disseminated intravascular coagulation, and serum sickness after large doses of immune globulin given intravenously for Kawasaki disease. , 1992, The Journal of pediatrics.

[25]  C. Putterman,et al.  Transient neutropenia induced by intravenous immune globulin. , 1992, The New England journal of medicine.

[26]  K. Anand,et al.  Halothane-morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery. , 1992, The New England journal of medicine.

[27]  Lippincott Williams Wilkins,et al.  Assessment: Magnetoencephalography (MEG) , 1992 .

[28]  D. Bridge,et al.  Cerebral infarction complicating intravenous immunoglobulin therapy for polyneuritis cranialis , 1992, Neurology.

[29]  J. Piette,et al.  Efficacy of intravenous gammaglobulin therapy in chronic refractory polymyositis and dermatomyositis: an open study with 20 adult patients. , 1991, The American journal of medicine.

[30]  D. Ross Monitoring L-thyroxine therapy: lessons from the effects of L-thyroxine on bone density. , 1991, The American journal of medicine.

[31]  M. Nicholls,et al.  Haemolysis induced by intravenously‐administered immunoglobulin , 1989, The Medical journal of Australia.

[32]  R. Gale,et al.  Clinical uses of intravenous immunoglobulins. , 1988, Seminars in hematology.

[33]  T Smith,et al.  New Year Message , 1988, British medical journal.

[34]  J. Mcmillan,et al.  Eczema after intravenous infusion of immunoglobulin. , 1987, British medical journal.

[35]  T. Delamothe The OPCS: many (more) happy returns? , 1987, British medical journal.

[36]  E. Fitzsimons,et al.  ALOPECIA AFTER IMMUNOGLOBULIN INFUSION , 1987, The Lancet.

[37]  G. Herrera,et al.  Acute cryoglobulinemic renal failure after intravenous infusion of gamma globulin. , 1987, The American journal of medicine.

[38]  D. Cournoyer,et al.  Hemolytic anemia following intravenous gamma globulin administration. , 1987, The American journal of medicine.

[39]  H. Scher,et al.  Bone metastases: pathogenesis, treatment, and rationale for use of resorption inhibitors. , 1987, The American journal of medicine.

[40]  E. Gelfand,et al.  Corticosteroids for prevention of adverse reactions to intravenous immune serum globulin infusions in hypogammaglobulinemic patients. , 1986, The American journal of medicine.

[41]  López Piñero Jm,et al.  New material and information about the History of the plants of New Spain by Francisco Hernandez , 1994 .

[42]  T. Scott Neurosarcoidosis , 1993, Neurology.

[43]  C. Diskin,et al.  Pharmacologic intervention to prevent hemodialysis vascular access thrombosis. , 1993, Nephron.

[44]  R. Brunkhorst,et al.  Glomerulonephritis associated with inflammatory demyelinating polyradiculoneuropathy: a case report and review of the literature. , 1993, Nephron.

[45]  A. Prince,et al.  Viral safety of solvent-detergent treated blood products. , 1993, Developments in biological standardization.

[46]  H. Suomalainen,et al.  Local immune response in patients with cow milk allergy: follow-up of patients retaining allergy or becoming tolerant. , 1992, The Journal of pediatrics.

[47]  B. Donatini Transient renal dysfunction in diabetic patients after IVIg therapy. , 1992, Journal of internal medicine.

[48]  J. Kobosko,et al.  Renal toxicity of intravenous immunoglobulin. , 1992, Clinical nephrology.

[49]  M. Dalakas,et al.  High-dose intravenous immunoglobulin in the treatment of demyelinating neuropathy associated with monoclonal gammopathy. , 1990, Neurology.

[50]  J. Goodgold Ethics, education and empire. , 1979, Archives of Physical Medicine and Rehabilitation.