Immediate infusion-related adverse reactions to intravenous immunoglobulin in a prospective cohort of 1765 infusions.

Intravenous immunoglobulin (IVIG) is increasingly recommended for many diseases apart from primary immunodeficiency diseases (PID). Although effective and safe, adverse reactions may occur. We conducted a 2-year prospective observational study in 117 patients with PID who received regular IVIG replacement therapy at a median dose of 600 mg/kg every 3 to 4 weeks to examine IVIG's adverse effects; 1765 infusions were performed (mean=15/patient) in 75 males and 42 females (aged 3 months to 77 years) in 3 groups: ≤ 9 years (34.2%), 10-19 years (26.5%), and ≥ 20 years (39.3%). Fifty patients had common variable immunodeficiency (CVID), 11 had X-linked agammaglobulinemia (XLA), and 55 had other immune system disorders. The drugs administered were Octagam® (49.1%), Tegeline® (17.3%), Imunoglobulin® (18.6%), Flebogama® (12.9%), Vigam® (1.2%), and Kiovig® (0.4%). Immediate infusion-related adverse reactions occurred in the cases of 38 out 1765 infusions (2.15%, IC95% 1.53%-2.94%), which were classified as mild (81.6%), moderate (10.5%), or severe (7.9%). Time until reaction ranged from 10 to 240 min (mean = 85.7, median = 60). Reaction rates were similar across age groups. The most common reactions were malaise, headache, and abdominal pain. Reported severe events were tightness of the throat and seizure. All symptoms improved with temporary or complete IVIG interruption and symptomatic medications. Sixteen of 38 reactions to infusions occurred in the presence of an acute infection (p=0.09). Tegeline® represented a greater reaction risk factor than Octagam® (p < 0.001). These results indicate that IVIG infusion can be considered a safe procedure. Low reaction incidence and few severe immediate infusion-related adverse reactions were observed.

Impacto do tratamento com imunoglobulina humana intravenosa no número de pneumonias em pacientes com deficiência de anticorpo / Efficacy of immunoglobulin therapy in reducing pneumonia

A imunodeficiência comum variável (ICV) e a agamaglobulinemia ligada ao X (ALX) são imunodeficiências primárias caracterizadas por deficiência de anticorpos e susceptibilidade aumentada a infecções, sendo a pneumonia a infecção mais frequente. Esses pacientes são tratados com infusões regulares de imunoglobulina intravenosa (IGIV). Objetivo: Avaliar a frequência de pneumonias e o impacto do tratamento com IGIV em 25 pacientes com ICV ou ALX. Métodos: Análise retrospectiva dos prontuários médicos de pacientes com diagnóstico confirmado de ICV ou ALX, em tratamento regular com IGIV. Resultados: Analisamos 25 pacientes (18 com ICV e 7 com ALX; 14 homens e 11 mulheres; média de idade atual de 18 anos). A média de idade ao início dos sintomas foi de 5,7 anos e a média de idade ao diagnóstico foi de 11,5 anos. Treze pacientes (52%) apresentaram pneumonia como primeira manifestação da imunodeficiência. A pneumonia foi a infecção mais frequente nesses pacientes antes do diagnóstico – 22 pacientes (88%) tiveram pelo menos um episódio de pneumonia antes do diagnóstico e, desses, 59% tiveram mais do que 5 episódios – antes do diagnóstico houve uma média de 6,2 episódios de pneumonia por paciente. Após início do tratamento com IGIV, 10 pacientes (40%) tiveram algum episódio de pneumonia, com uma média de 1,5 episódio por paciente. Nove pacientes (36%) apresentavam algum tipo de sequela pulmonar antes do diagnóstico da imunodeficiência. Conclusão: O tratamento com IGIV é eficaz na redução dos episódios de pneumonia nesses pacientes. O diagnóstico e tratamento precoces são de extrema importância.

Common variable immunodeficiency (CVID) and X-linked agammaglobulinemia (XLA) are primary immune disorders characterized by antibody deficiency and increased susceptibility to infections, especially pneumonia. Replacement therapy with intravenous immunoglobulin (IVIG) is the standard treatment. Objective: To assess the frequency of pneumonia in 25 patients with CVID or XLA and the effectiveness of intravenous immunoglobulin replacement therapy in these patients. Methods: a descriptive study, based on a retrospective analysis of medical records from 25 patients with diagnosis of CVID or XLA treated with IVIG. Results: A total of 25 patients were studied (18 with CVID and 7 with XLA; 14 male and 11 female; mean current age, 18 years). The mean age of onset of symptoms was 5.7 years and the mean age of diagnosis was 11.5 years. Pneumonia was the most common primary clinical presentation (13 patients – 52%). Twenty-two (88%) of the 25 patients had pneumonia at least once before diagnosis and 13 out of 22 of these patients had more than 5 episodes. Pre-diagnosis patients had an average of 6.2 episodes of pneumonia. After treatment with IVIG, ten patients (40%) had pneumonia – with an average of 1.5 episode of pneumonia per patient. Conclusion: IVIG treatment provides a remarkable reduction in pneumonia in these patients. Early diagnosis and treatment is mandatory for a positive prognosis.