Substitution therapy in immunodeficient patients with anti-IgA antibodies or severe adverse reactions to previous immunoglobulin therapy.

BACKGROUND: Patients with common variable immunodeficiency often suffer from recurrent bacterial infections. Administration of immunoglobulins is a well-established treatment to reduce the frequency and severity of these infections. However, in patients with anti-IgA antibodies or side effects to previous immunoglobulin substitution therapy, administration of immunoglobulins may lead to anaphylactoid reactions. OBJECTIVE: To describe the feasibility of immunoglobulin substitution therapy in patients with anti-IgA antibodies or side effects to previous immunoglobulins. METHODS: A retrospective study was conducted in two university hospital outpatient clinics. Fourteen patients with common variable immunodeficiency were found to have circulating anti-IgA antibodies or have experienced severe reactions to previously administered blood products. RESULTS: In eight out of 15 patients side effects to immunoglobulins and/or blood transfusions had occurred previously. In four patients these reactions were due to anti-IgA antibodies. No side effects were observed when human immunoglobulin 16% was given by subcutaneous infusion. In all patients with anti-IgA antibodies, as well as in those without, subcutaneous immunoglobulins were well tolerated. In some patients antibodies disappeared and therapy could be changed into intravenous immunoglobulin administration. CONCLUSIONS: Patients with serious side effects to previous immunoglobulin therapy and/or blood transfusions can be safely treated with subcutaneous immunoglobulins and, if necessary, with intravenous immunoglobulins at a later point in time.

The effect of two different dosages of intravenous immunoglobulin on the incidence of recurrent infections in patients with primary hypogammaglobulinemia. A randomized, double-blind, multicenter crossover trial.

BACKGROUND: In patients with hypogammaglobulinemia, substitution with immunoglobulin is the treatment of choice to reduce both frequency and severity of bacterial infections. Even with treatment, however, infections still occur in these patients. OBJECTIVE: To determine whether doubling the standard dose of intravenous immunoglobulin would affect the incidence and duration of infections. DESIGN: Multicenter, double-blind, randomized, crossover study. SETTING: 15 outpatient clinics in the Netherlands. PATIENTS: 43 patients with primary hypogammaglobulinemia, 41 of whom completed the protocol. INTERVENTION: Patients received standard-dose immunoglobulin therapy for 9 months, followed by a 3-month washout period, and high-dose intravenous immunoglobulin therapy for 9 months, or vice versa. MEASUREMENTS: The primary outcome measures were total number and duration of infections. Other measures were periods of fever, hospital admissions, use of antibiotics, absence from school or work, and trough levels of serum immunoglobulin. Side effects from the study medication were also recorded. RESULTS: Compared with the standard dose of intravenous immunoglobulin (adults, 300 mg/kg of body weight every 4 weeks; children, 400 mg/kg every 4 weeks), high-dose therapy (adults, 600 mg/kg every 4 weeks; children, 800 mg/kg every 4 weeks) significantly reduced the number (3.5 vs. 2.5 per patient; P = 0.004) and duration (median, 33 days vs. 21 days; P = 0.015) of infections. Trough levels of IgG increased significantly during high-dose therapy. The incidence and type of side effects did not differ significantly for the two dosages. CONCLUSION: In patients with hypogammaglobulinemia, doubling the standard dose of intravenous immunoglobulin significantly reduced the number and duration of infections.

Evaluation of the Organon Teknika Plasmapur system with new software and two types of filter.

A convenient plasmapheresis apparatus is the Plasmapur system (Organon Teknika). Recently the software of the Plasmapur monitor has been changed. We evaluated the modified Plasmapur monitor and two types of Plasmapur separators containing polypropylene membranes with a mean maximum pore size of 0.5 mum and 0.6 mum respectively. 50 plasmaphereses with each separator were performed; during 10 procedures donor blood samples and samples from the plasma obtained were drawn. No hypersensitivity reactions were observed, the operator "hands on" time was less than 5 min, the mean procedure time was 45 min to collect 650 mL of plasma with both types of filters. Biochemical analysis of the samples indicated that with both separators the plasma obtained was of good quality with respect to Factor VIII and other proteins and that no significant activation of the complement or clotting cascades occurred.