title: Optimizing immunoglobulin treatment for patients with primary immunodeficiency disease to prevent pneumonia and infection incidence: review of the current data.
abstract: BACKGROUND
  An increasing body of evidence suggests that the optimal dose for IgG replacement therapy is the dose that keeps the patient as free from infection as possible by either intravenous or subcutaneous delivery.
  
  
  OBJECTIVE
  To review the current evidence on optimizing IgG therapy in patients with primary immunodeficiency disease (PIDD).
  
  
  METHODS
  Surveys conducted among physicians who treat patients with PIDD indicate that most practitioners follow existing data and guidelines on the use and dosage of immunoglobulin therapy. On the basis of the current guidelines, most use intravenous immunoglobulin (IVIG) therapy at a starting dose of 400 mg/kg every 4 weeks to treat a number of primary PIDDs with humoral immune deficiencies. However, for the optimal treatment of PIDDs, therapy needs to be tailored.
  
  
  RESULTS
  Among the issues is the assessment of IgG trough levels or steady-state levels with subcutaneous immunoglobulin (SCIG) therapy needed to reduce or prevent infection in patients with PIDD. Increasing evidence suggests that optimization of treatment can be based on identifying the dosage of IVIG or SCIG for each patient needed to reduce infection.
  
  
  CONCLUSIONS
  More studies are needed to better clarify the optimal dose, IgG trough level, or IgG steady-state level necessary to reduce infection and optimize treatment for patients with PIDD treated with IVIG or SCIG.
authors.affiliation: Division of Allergy and Immunology, Women & Children's Hospital of Buffalo, SUNY Buffalo, School of Medicine, Buffalo, New York; Department of Pediatrics, Division of Allergy, Immunology and Pediatric Rheumatology, University of South Florida, St Petersburg, Florida. Electronic address: mballow@health.usf.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Ballow
mesh_terms: D001424:Bacterial Infections / Q000517:prevention & control*; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007153:Immunologic Deficiency Syndromes / Q000628:therapy*; D011014:Pneumonia / Q000517:prevention & control*; D014777:Virus Diseases / Q000517:prevention & control*
chemical_list: D007074:Immunoglobulin G