Administering intravenous immunoglobulin during infection is associated with infusion reactions in selected patients.
BACKGROUND
Guidelines vary regarding the safety of administering intravenous immunoglobulin (IVIG) during infections, although evidence for this advice is lacking and is based on expert opinion.


OBJECTIVE
We retrospectively studied patients with common variable immunodeficiency who reacted during IVIG therapy as to whether routinely obtained markers of infection such as C-reactive protein (CRP) were elevated.


METHODS
19 patients on replacement IVIG therapy in a hospital-based infusion unit were studied. CRP levels obtained were normalized to baseline levels without reactions (defined as 100).


RESULTS
8 of 19 patients had 16 reactions over a total of 107 infusions. Normalized CRP levels during reactions were higher [mean (±SD) of 258 (±215)] than during infusions with no reaction [mean 100 (±54.9), p = 0.017], and higher than in patients who did not react [mean 100 (±79.7), p = 0.017].


CONCLUSIONS
Some patients with IVIG reactions had elevated CRP levels suggesting that concurrent infection may have caused the reaction. Pre-emptive antibiotic therapy and delaying infusion could prevent unnecessary morbidity.
Department of Immunology, Frimley Park Hospital NHS Foundation Trust, Frimley, Camberley, Surrey, GU16 7UJ, UK. sujoy.khan@fph-tr.nhs.uk
S
S
Khan
M
M
Abuzakouk
P C
PC
Doré
W A C
WA
Sewell
D002097:C-Reactive Protein / Q000032:analysis; D017074:Common Variable Immunodeficiency / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D007262:Infusions, Intravenous; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012189:Retrospective Studies
D016756:Immunoglobulins, Intravenous; D002097:C-Reactive Protein