title: [Adverse effects with ambulatory intravenous immunoglobulin administration in adult patients with common variable immunodeficiency].
abstract: BACKGROUND
  Common variable immunodeficiency (CVID) is the most frequent symptomatic primary immunodeficiency, affecting 1:25,000-75,000 people. It is characterized by the absence or decrease antibody production. Treatment for CVID consists on human immunoglobulin administration, and the intravenous route is the most common route for administration, at 400-800 mg/kg of weight every 3-4 weeks. Adverse effects associated with intravenous immunoglobulin (IVIg) use occur in 25% of all infusions, with severe adverse reactions presenting in less than 1% of all patients. Acute renal failure can occur as a severe adverse reaction, which presents 1-10 days after starting IVIg treatment. In our center we implemented an ambulatory scheme for IVIg administration, which allows its administration in an average of 3 hours, without severe adverse effects.
  
  
  OBJECTIVE
  To describe adverse effects and to evaluate the frequency of renal failure secondary to ambulatory IVIg administration in patients with common variable immunodeficiency.
  
  
  METHODS
  A descriptive and prospective study was done including adult patients con definitive diagnosis of common variable immunodeficiency, receiving IVIg at replacement dose every 3 weeks. All patients were evaluated with clinical exploration, somatometry, serum creatinine, albumin and urea determination, 24 hours creatinine clearance, glomerular filtration rate with CKD-EPI, and immediate renal function associated with accumulated IVIg. Results were analyzed with descriptive statistics.
  
  
  RESULTS
  We determined adverse effects in 25 patients with common variable immunodeficiency (15 women and 10 men, average age 36.7 years), during a 10 months period (January-September 2013). During this period 284 IVIg infusions were administered using our scheme, frequency of adverse effects were 12.9%, with 5.2% of early adverse effects and 7.7% late adverse effects, all being mild to moderate, in some cases required analgesic and/or antihistamine administration, without having to stop the IVIg infusion. In the renal function study 19 patients were included (12 women and 7 men, average age 36 years, average weigh 58.74 kg and average height 1.60 m), evaluated from January 2009 to October 2013. Average serum creatinine was 0.76 ± 0.18 mg/dL, average serum urea was 28.6 ± 7.6 mg/dL, none patient presenting acute renal failure. Glomerular filtration rate was determined with CKD-EPI formula, and the average was 116 ± 34 mL/min/1.73 m2, finding chronic renal failure in 4 patients. Average 24 hours creatinine clearance was 98.64 ± 22 mL/min/1.73 m2, with chronic renal failure data in 6 patients.
  
  
  CONCLUSIONS
  There were no severe adverse effects with this ambulatory IVIg scheme (anaphylaxis, acute renal failure). We did not find data of acute renal failure secondary to IVIg administration in this population, but we did find data of chronic renal failure secondary to IVIg administration through 24 hours creatinine clearance in 6 patients. No relation was found between accumulated IVIg dose in the last 5 years and decreased glomerular filtration rate. Another benefit worth of mentioning with this scheme is the reduction in costs for the health institution and to the patient.
authors.affiliation: Servicio de Alergia e Inmunología Clínica, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, DF. norasegura@yahoo.com; karen_aicila@hotmail.com.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Rodríguez-Mireles
authors.forename: Angélica
authors.initials: A
authors.lastname: Galguera-Sauceda
authors.forename: Arturo
authors.initials: A
authors.lastname: Gaspar-López
authors.forename: Eunice G
authors.initials: EG
authors.lastname: López-Rocha
authors.forename: Freya
authors.initials: F
authors.lastname: Campos-Romero
authors.forename: Leonel
authors.initials: L
authors.lastname: Del Rivero-Hernández
authors.forename: Adela
authors.initials: A
authors.lastname: Amaya-Mejía
authors.forename: Lucy
authors.initials: L
authors.lastname: Galindo-Pacheco
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Farril-Romanillos
authors.forename: Nora Hilda
authors.initials: NH
authors.lastname: Segura-Méndez
keywords: Adverse effects; Common variable immunodeficiency; Intravenous immunoglobulin; Renal complications