title: Subcutaneous immunoglobulin: rapid push vs. infusion pump in pediatrics.
abstract: BACKGROUND
  Subcutaneous immunoglobulin (SCIG) therapy is gaining favor for the management of primary immunodeficiency disease (PIDD) in adults and children.
  
  
  METHODS
  A retrospective chart review captured data on 96 pediatric patients with PIDD using SCIG (16% or 20%) delivered by infusion pump or SC rapid push over 620 clinic visits. Patients previously using intravenous immunoglobulin (IVIG) were converted to SCIG dosing on a 1:1 basis. Patients/caregivers voluntarily chose an administration technique.
  
  
  RESULTS
  Although mean SCIG dosing was lower on a g/kg/month basis compared with prior IVIG dosing, mean steady-state serum IgG levels during SCIG administration were about 100-200 mg/dl higher than IVIG trough values. On average, much more rapid infusion was achieved with the SC rapid push method, with 49% of patients reporting infusion times of 9 min or less; median duration of infusion pump administration was 45 min. The use of 20% SCIG increased dosing efficiency compared with 16% SCIG, allowing for a smaller weekly mean SCIG volume and fewer dosing days per week. Adverse event (AE) rates were lower in the pediatric subgroup compared with adults (15.8% vs. 18.8% of visits), and the majority of AEs were local. SC rapid push was reported most frequently for patients under age 2; its use decreased between ages 2 and <10 yr and then increased in adolescence and into adulthood. Only one of the pediatric patients returned to IVIG use.
  
  
  CONCLUSIONS
  Administration of replacement Ig via SC rapid push is a safe and viable option in pediatric patients with PIDD.
authors: Midwest Immunology Clinic, Plymouth, MN, USA. rshapiro@midwestimmunology.com
authors: Ralph S
authors: RS
authors: Shapiro
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007136:Immunoglobulins / Q000008:administration & dosage* / Q000627:therapeutic use; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000627:therapeutic use; D007153:Immunologic Deficiency Syndromes / Q000097:blood / Q000628:therapy*; D007223:Infant; D007260:Infusion Pumps; D055104:Infusions, Subcutaneous / Q000379:methods*; D008297:Male; D010372:Pediatrics; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous