Appropriate therapeutic use of immunoglobulin

Abstract

ment of certain disorders associated with toxins (eg, diphtheria), in certain bites (eg, snake and spider), as a specific (eg, Rho[D] immune globulin), or nonspecific (eg, antilymphocyte serum) immunosuppressant, and in the treatment of certain infectious diseases. Three types of preparations are used in passive immunization: (1) standard human immune serum globulin (ISG) for general use; this is available in two forms-intramuscular immune globulin (IG) and intravenous immune globulin (IVIG); (2) special IGs with a known antibody content for specific illnesses, and (3) animal serums and antitoxins. These are listed in Table 1. Most of the licensed special immune globulins are for intramuscular use only. Whole blood, plasma, or serum can also be used in passive immunization. Passive immunization is not always effective; the duration is short and variable (1 to 6 weeks), and undesirable reactions may occur, especially if the antiserum is of nonhuman origin. ISG and special IGs are identical except that the latter are derived from patients hyperimmunized or convalescing from a specific infection, and the antibody content to the specific antigen is assayed; they are useful in several disorders in which IG is of little or no value.