ABSTRACT
Intravenous immunoglobulin (IVIG) replacement therapy improves health-related quality of life in patients with a primary immunodeficiency disease, although there have been reports of adverse reactions associated with its regular administration. The study population was composed of 99 patients with primary antibody deficiencies. All the patients were diagnosed with a primary immunodeficiency disease and received at least 4 infusions of IVIG at the Children's Medical Center Hospital, Tehran, Iran over a 13-year period (1995-2007). A total of 3004 infusions were recorded, and 216 (7.2%) of these were associated with adverse reactions in 66 patients. Adverse reactions were classified as mild (172 reactions), moderate (41 reactions), and severe (3 reactions). The rate of adverse reaction varied by diagnosis from 3.35% in patients with X-linked agammaglobulinemia to 17.4% in IgG subclass deficiency. There were no age-related differences in the rates of adverse reactions. Adverse reactions to IVIG infusions are occasionally encountered; therefore, physicians and nurses should be aware of these reactions in order to manage and prevent them.
Subject(s)
Desensitization, Immunologic , Drug-Related Side Effects and Adverse Reactions/immunology , Immunoglobulins, Intravenous/adverse effects , Immunologic Deficiency Syndromes/therapy , Adolescent , Adult , Age Factors , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Bacterial Infections/etiology , Bacterial Infections/immunology , Bacterial Infections/therapy , Child , Child, Preschool , Drug Compounding , Drug-Related Side Effects and Adverse Reactions/prevention & control , Female , Follow-Up Studies , Humans , Immunoglobulins, Intravenous/administration & dosage , Immunologic Deficiency Syndromes/complications , Immunologic Deficiency Syndromes/immunology , Infant , Infusions, Intravenous , Iran , Male , Middle Aged , Opportunistic Infections/etiology , Opportunistic Infections/immunology , Opportunistic Infections/therapy , Quality of LifeABSTRACT
INTRODUCTION: Intravenous immunoglobulin (IVIG) is an important research topic because of its efficacy in the management of an increasing number of diseases, its high cost and limited availability. This study was designed to evaluate the paediatric inpatient use of IVIG and identify strategies to reduce the drug expenditures. METHODS: Over a six-month period, physician and nursing charts, and notes for subjects who were treated with IVIG, were reviewed to gather the required data. This included patient demographics, IVIG, indications, dosage regimen, adverse drug reactions (ADRs) and their management. RESULTS: 58.3 percent of IVIG infusions were ordered for labelled indications. Patients in the labelled group experienced more clinical improvement than subjects in the off-label group. Haematologists and neurologists were the most prevalent prescribers. ADRs were more prevalent in the off-label group. Hypotension, fever, headache and chills were the most common adverse effects. ADRs were managed with drugs in 22.9 percent of IVIG administrations and IVIG infusions were modified in 12.5 percent of infusions. CONCLUSION: ADRs were more prevalent in this hospital than those reported by other authors. This may be due to nursing negligence of the recommended infusion rate, higher sensitivity of our population or to the brands of IVIG which are used in the hospital. This shows the need for further evaluation of IVIG prescription and administration.
