Preliminary Guidelines for the Use of IVIg during COVID-19

David S Younger

doi:10.4236/wjns.2021.112015

Abstract

Infection with the severe acute respiratory syndrome novel type-2 novel coronavirus (SARS-CoV-2) responsible for the 2019 coronavirus disease (COVID-19) shows a highly heterogeneous clinical presentation and age affliction in children and adults, ranging from asymptomatic or mild disease to severe involvement, with potentially fatal respiratory failure and multiple organ dysfunction. As susceptibility to severe COVID-19 depends upon comorbid factors including immune competence, optimizing the latter through low-dose supplementation or high dose treatment with immune globulin therapy in those with primary immune deficiency and post-infectious immune sequelae of SARS-CoV-2 and existing autoimmune disorders is essential. There are no existing guidelines hence; this paper provides a framework for considering preliminary guidelines for the use of immune globulin therapy during COVID-19.

Highlights

Background and RationaleSARS-CoV-2 infection triggers a dysregulated innate and adaptive immune response accompanied by hyperinflammation known as the cytokine storm [1] during which the viral escapes from innate sensing the interferon I (IFN-I) pathway, with activation of myeloid cells, depletion of T-cells, NK T-cell dysfunction, and hemostatic imbalance with widespread clotting
There are no existing guidelines ; this paper provides a framework for considering preliminary guidelines for the use of immune globulin therapy during COVID-19
1) IVIg-HD is indicated in all patients acute severe COVID-19 to ameliorate the post-infectious autoimmune cytokine storm and widespread clotting due to complement-mediated thrombotic microangiopathy (TMA)

Summary

Background and Rationale

SARS-CoV-2 infection triggers a dysregulated innate and adaptive immune response accompanied by hyperinflammation known as the cytokine storm [1] during which the viral escapes from innate sensing the interferon I (IFN-I) pathway, with activation of myeloid cells, depletion of T-cells, NK T-cell dysfunction, and hemostatic imbalance with widespread clotting. IVIg-HD has been used in the empiric treatment of post-acute sequela of COVID-19 (PASC) [10] This disorder is defined by the National Institutes of Health [11] as new or persistent organ-related symptoms lasting longer than one month after initial infection. Vulnerable individuals including those ineligible or hesitant to vaccinate, and pre-existing immune deficiency or autoimmune illness, as well as others recovering from SARSCoV-2-related exposure with acquired immune deficiencies, may benefit from monthly low-dose (LD) (400 - 500 mg/kg) (IVIg-LD) or standard subcutaneous (SC) Ig therapy to restore normal host immunity [12]. This article provides a series of recommendations for clinicians, patients, and lay groups on this subject

Limitations

Severe COVID-19

Genetic and Acquired Immune Deficiency

Autoimmunity

Conclusion

Recommendations