From immune substitution to immunomodulation.
Intravenous immunoglobulins (IVIGs) are currently used in many fields of medicine for replacement and immunomodulation. This review focuses on the milestones in the history of human immunoglobulins since the initial observation by Ogden C. Bruton who described replacement therapy in a boy with agammaglobulinemia. Since then, the preparations used for treatment have been markedly improved with respect to tolerability, clinical efficacy, and pathogen safety. Preparations and appropriate pumps for subcutaneous administration of IgG have been developed and offer an alternative mode of treatment for immunodeficient patients. Appropriate replacement today allows patients with humoral immunodeficiencies to reach adulthood and normal or near-normal quality of life. In 1981 a second fundamental discovery was made. Paul Imbach and coauthors in children with idiopathic thrombocytopenic purpura (ITP) showed that IVIG has immunomodulatory potential, offering a chance for affected children to receive effective treatment with little or no side effects compared to systemic corticosteroids. This new principle of treatment encouraged many researchers worldwide to exploit the potential of IVIG in many other immunopathological situations. As an example, Rhesus hemolytic disease in newborn babies is discussed.
Department of Pediatric Pulmonology and Immunology, Charité University Hospital, Berlin, Germany. Electronic address: volker.wahn@charite.de.
Volker
V
Wahn
D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D056747:Immunomodulation / Q000276:immunology*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D011788:Quality of Life; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous
ITP; Immunomodulation; Intravenous immunoglobulin; Replacement therapy; Rhesus hemolytic disease