title: Long-Term Treatment and Transfusion of Normal Blood Components Following Tolerance Induction in Patients with Anti-IgA Anaphylactic Reactions.
abstract: BACKGROUND
  In general, patients with significant anti-Ig-A do not tolerate intravenous (i.v.) administration of normal blood products. Here, we present our experiences in the induction of immune tolerance (IIT) and long-term treatment in a series of such patients affected in such a way. The question whether blood components from IgA-deficient donors are required will be discussed.
  
  
  METHODS
  Ten adult patients (4 females and 6 males; age ranging from 36 to 75 years) with anti-IgA were included in this study. All patients required long-term treatment with blood components. One patient had IgA deficiency and paroxysmal nocturnal hemoglobinuria (PNH), and all other patients had common variable immunodeficiency (CVID). The particle gel immunoassay was used for the detection of anti-IgA. Immune tolerance to IgA was induced by controlled subcutaneous (s.c.) and/or i.v. infusions of IgG preparations.
  
  
  RESULTS
  Prior to IIT, anti-IgA was detectable in plasma samples of all patients and significantly diminished or abolished by controlled s.c. and/or i.v. infusions of IgG. Multiple transfusions with normal blood components could be repeatedly performed with the patient suffering from PNH without any complications. As long as i.v. IgG (IVIgG) infusions were consequently administered as individually required (intervals 2-8 weeks), none of the patients developed reactions during observation (up to 10 years). However, interruption of treatment and re-exposure to IVIgG resulted in adverse reactions.
  
  
  CONCLUSIONS
  Patients with significant anti-IgA can be safely desensitized and tolerate long-term IgG substitutions independent of the IgA concentration of the used blood component.
authors.affiliation: Transfusion Medicine, Charité University Medicine - Campus Virchow Klinikum, and ZTB, Zentrum für Transfusionsmedizin und Zelluläre Therapie, Berlin, Germany.
authors.forename: Abdulgabar
authors.initials: A
authors.lastname: Salama
authors.affiliation: Transfusion Medicine, Charité University Medicine - Campus Virchow Klinikum, and ZTB, Zentrum für Transfusionsmedizin und Zelluläre Therapie, Berlin, Germany.
authors.forename: Romina
authors.initials: R
authors.lastname: Kardashi
authors.affiliation: Transfusion Medicine, Charité University Medicine - Campus Virchow Klinikum, and ZTB, Zentrum für Transfusionsmedizin und Zelluläre Therapie, Berlin, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Arbach
keywords: Anaphylactic reactions; Anti-IgA; IVIgG; IgA anaphylaxis; IgA deficiency; Immune tolerance; Transfusion reactions