Use Of Immunoglobulin Therapy Research Articles

Continuous increase of immunoglobulin therapy in Iceland

• Immunoglobulin therapy is a beneficial treatment for a variety of registered and off-label • indications and use of immunoglobulin treatment has been continually increasing. We confirmed the increasing use of immunoglobulin in Iceland and conclude that continually increasing demand and global shortage dictates careful consideration of indications before initiating treatment with immunoglobulins. The use of immunoglobulin treatment has been increasing for various indications. The objective of this study was to evaluate clinical use of immunoglobulin therapy in Iceland, estimate off-label usage and describe possible changes in this treatment option. All prescriptions for intravenous or subcutaneous immunoglobulin treatment require authorisation from Landspitali University Hospital. Patient information is registered and was retrieved for the period 2010 to 2019. A total of 921 patients received immunoglobulin treatment in the study period, intravenous therapy was given in 895 (97.2%) of the cases. Registered indications were 667, off-label indications were 245 and uncertain were nine. The total annual number of patients receiving immunoglobulin treatment increased from 87 in 2010 to 392 in 2019. The increase in immunoglobulin usage was both for registered and off-label indications, 61 to 309 and 26 to 83, respectively. Continually increasing demand and global shortage dictates careful consideration of indications before initiating or continuing treatment with immunoglobulins. With global shortage of immunoglobulins, careful consideration and patient selection is important. Increasing immunoglobulin usage improves treatment for many patients. However, immunoglobulins are a limited resource and prudent use is imperative.

Meningitis aséptica secundaria a la administración de inmunoglobulina

Introducción: la meningitis aséptica es una entidad infrecuente y multifactorial, siendo raros los efectos secundarios a la administración de inmunoglobulina. Objetivo: reportar el caso de una paciente hospitalizada en el servicio de pediatría en un hospital de Bogotá. Discusión: las principales causas de la entidad son virales. Aunque el uso de inmunoglobulina en pediatría es seguro, uno de sus efectos adversos menos comunes es la meningitis aséptica. Están descritas las posibles teorías fisiopatológicas que podrían explicar su desenlace. Conclusión: la meningitis aséptica puede corresponder a un efecto secundario al uso de inmunoglobulina en pediatría.

Management of chronic lymphocytic leukemia in Canada during the coronavirus pandemic.

The emergence of the covid-19 disease pandemic caused by the 2019 novel coronavirus has required a re-evaluation of treatment practices for clinicians caring for patients with chronic lymphocytic leukemia (cll). The American Society for Hematology (ash) has provided a series of recommendations for the treatment of patients with cll during the pandemic, covering a range of topics, including testing for covid-19, cll treatment initiation and selection, use of immunoglobulin therapy, in-person monitoring, and treatment of patients with cll and covid-19. We summarize the ash recommendations and discuss their applicability as guidelines for the treatment of cll during the covid-19 pandemic in Canada.

The effectiveness and safety of immunoglobulintherapy for various human pathologies V. E. Kazmirchuk (Kyiv, Ukraine)

Work begins from a large historical background the emergence of the doctrine of immunoglobulins. A brief review of the development of world achievements in the use of immunoglobulin therapy is given. We give the rationale for the treatment of various human diseases in situations of ineffective protocol treatment, the principles of searching for the etiology and making the correct diagnosis. Often a visit to an immunologist is the only hope of the patient in solving the health problem. Several cases from hundreds of patients observed by us are described. All medical professionals working according to the protocols themselves should be referred to the immunologist in cases of lack of diagnosis or ineffective treatment. Treatment of patients should begin with the establishment of an etiological factor in any disease, even in cases of oncology. Until the root cause of the disease has been identified, treatment cannot be effective. The use of immunoglobulin therapy has no contraindications, and its effectiveness and safety are presented in the work.

National Immunoglobulin Replacement Expert Committee Recommendations

The use of immunoglobulin therapy has grown steadily over the past 3 decades, mainly due to the increased awareness and expansion of indications. This limited resource is now shared between patients with immunodeficiency disorders who need it as replacement therapy, and individuals who suffer a variety of autoimmune or inflammatory disorders. While alternative therapies exist for the latter diseases, immunodeficient patients are dependent upon this treatment for life. Due to the long-term cost burden of this treatment on healthcare systems, healthcare providers have attempted to moderate its use but are frequently seeking evidence from experts in the field. This raised the critical need for recommendations from experts. To this end, a group a Canadian immunologists representing all regions of the country have formed a panel, the National Immunoglobulin replacement Expert Committee (NIGEC), and formulated a set of unanimously agreed upon recommendations for the use of immunoglobulin replacement in primary ...

The use of Immunoglobulin Therapy in Primary Immunodeficiency Diseases.

Immunoglobulin therapy represents a lifesaving intervention for many patients with primary immunodeficiency (PID). Antibody defects represent approximately half of the well-known PIDs requiring immunoglobulin replacement therapy. Following immunoglobulin therapy in PID patients, protection against serious upper and lower respiratory tract infections and pulmonary function improves which leads to an increase in the quality of life of these patients. Successful treatment of PID patients depends on the type of immunodeficiency, regular monitoring of the patient, comorbidities of the patient, and the availability of the products.

A Canadian perspective on the use of immunoglobulin therapy to reduce infectious complications in chronic lymphocytic leukemia.

Infections are a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (cll), who typically have increased susceptibility because of hypogammaglobulinemia (hgg) related to their disease and its treatment. Immunoglobulin replacement therapy (igrt) has been shown to reduce the frequency of bacterial infections and associated hospitalizations in patients with hgg or a history of infection, or both. However, use of igrt in cll is contentious. Studies examining such treatment were conducted largely before the use of newer chemoimmunotherapies, which can extend lifespan, but do not correct the hgg inherent to the disease. Thus, the utility of igrt has to be re-evaluated in the current setting. Here, we discuss the evidence for the use of igrt in cll and provide a practical approach to its use in the prevention and management of infections.

Recommendations for the use of immunoglobulin therapy for immunomodulation and antibody replacement.

Polyvalent immunoglobin, derived from pooled human plasma, can be administered via the intravenous, subcutaneous or intramuscularroute. Therapy is standard of care in the treatment of a number of immune-mediated pathologies across disciplines. By volume, the majorityis used in neurology (~40%). In primary immunodeficiencies, therapy reconstitutes humoral immunity at replacement doses (0.4 - 0.6 g/kg/month), decreasing infections, and is usually lifelong. However, high doses, usually 2 g/kg total dose over five days, are required forimmunomodulation in autoimmune and inflammatory indications. A high-quality evidence base supports use in primary antibody failure,Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, acute idiopathic thrombocytopenia, Kawasaki disease andimmunobullous diseases. Low-quality evidence shows benefit in many other uncommon autoimmune and immunodeficient conditions.In South Africa, use of immunoglobulin therapy is restricted and, given the cost involved, will likely remain so. Therefore, the incrementalbenefit over other forms of immunosuppression, particularly corticosteroids, must be assessed carefully on a case-by-case basis. In mostcases, therapy will be second-line or 'rescue' and motivation will be required. This short review aims to provide clinicians with the necessaryunderstanding of the therapy, general considerations for use, and evidence base and quality thereof for well-established indications.

Intravenous Immunoglobulin in the Management of Lupus Nephritis

The occurrence of nephritis in patients with systemic lupus erythematosus is associated with increased morbidity and mortality. The pathogenesis of lupus nephritis is complex, involving innate and adaptive cellular and humoral immune responses. Autoantibodies in particular have been shown to be critical in the initiation and progression of renal injury, via interactions with both Fc-receptors and complement. One approach in the management of patients with lupus nephritis has been the use of intravenous immunoglobulin. This therapy has shown benefit in the setting of many forms of autoantibody-mediated injury; however, the mechanisms of efficacy are not fully understood. In this paper, the data supporting the use of immunoglobulin therapy in lupus nephritis will be evaluated. In addition, the potential mechanisms of action will be discussed with respect to the known involvement of complement and Fc-receptors in the kidney parenchyma. Results are provocative and warrant additional clinical trials.

Diretrizes para o manejo do tétano acidental em pacientes adultos

Although tetanus can be prevented by appropriate immunization, accidental tetanus continues to occur frequently in underdeveloped and developing countries. Tetanus mortality rates remain high in these areas, and studies regarding the best therapy for tetanus are scarce. Because of the paucity of data on accidental tetanus and the clinical relevance of this condition, the Associação de Medicina Intensiva Brasileira (AMIB) organized a group of experts to develop these guidelines, which are based on the best available evidence for the management of tetanus in patients requiring admission to the intensive care unit. The guidelines discuss the management of tetanus patients in the intensive care unit, including the use of immunoglobulin therapy, antibiotic therapy, management of analgesics, sedation and neuromuscular blockade, management of dysautonomia and specific issues related to mechanical ventilation and physiotherapy in this population.

Chicken egg yolk antibodies (IgY) as an alternative to mammalian antibodies

Chicken eggs present an ideal alternative antibody source to mammals, as the IgY in the chicken’s blood is transported to the egg and accumulates in the egg yolk in large quantities. The existence of an IgG like molecule in avian eggs, referred to as IgY, has been well documented in recent studies and extensive research has been carried out on its characterization, production and purification. The yolks of eggs laid by immunized chicken have been recognized as an excellent source of polyclonal antibodies for over a decade. This simple non invasive approach presents an appealing alternative to conventional polyclonal antibody production methods. The use of immunoglobulin therapy broadens the arsenal available to combat pathogens in medicine and IgY is a promising candidate, both as an alternative to antibiotics and as a useful tool in research and diagnostics. Keywords: Chicken antibody IgY; antivenom; passive immunotherapy; Salmonella.

Guidelines for the Use of Immunoglobulin Therapy for Primary Immune Deficiency and Solid Organ Transplantation

Guidelines for the Use of Immunoglobulin Therapy for Primary Immune Deficiency and Solid Organ Transplantation

Pharmacoeconomics of immunoglobulins in primary immunodeficiency

Primary immunodeficiency disorders are associated with increased patient susceptibility to recurrent infections. Since the 1950s, intramuscular, intravenous and subcutaneous immunoglobulin products have been used to replace functionally deficient or absent immunoglobulins, reduce the incidence of infections and prevent organ damage caused by infections. This article aims to review the use of immunoglobulin therapy in primary immunodeficiency by focusing on costs, effectiveness, cost–effectiveness, supply and off-label use. To date, the economic burden of primary immunodeficiency is unknown. Past studies have supported minimal differences in effectiveness between intravenous and subcutaneous immunoglobulins. Subcutaneous therapy may be considered for patients who prefer treatment at home. The small number of economic evaluations and their methodological limitations precludes the recommendation of a specific product for use in primary immunodeficiency on pharmacoeconomic grounds. Demand for immunoglobulins has increased over time, leading to periodic shortages and emphasizing the importance of its appropriate use.

Editor’s Choice

Editor’s Choice

The role of intravenous immunoglobulin therapy in autoimmune and inflammatory disorders.

The first use of immunoglobulin therapy, historically, was in 1890 when Emil von Behring developed effective antiserum against diphtheria toxin, but only in the early 1970s technological advancements in the fractionation of plasma lead to the production of Ig preparations which could be administered intravenously. Intravenous Ig products are a mainstay for disorders such as: primary immunodeficiency, serious infections, autoimmune and inflammatory disorders. During autoimmune and systemic inflammatory disease IVIg exhibits a number of immune modulatory activities such as: Fc Receptor-mediated effects, modulation of complement, modulation of cytokine production, superantigens neutralization, antibodies neutralization by idiotype network, increased catabolism of IgG, but also biologic effects of other molecules present in IVIg preparations. Recent understanding about IVIg composition and mechanism of action can explain its therapeutic effect in autoimmune and inflammatory disorders. Nevertheless it is important to underline that IVIg is a heterogeneous product and it is difficult to determine the exact mechanism of its activities in every disease. The increased use of IVIg in the treatment of autoimmune disorders outlined the issue of tolerability. Undesiderable effects to IVIg occurs in less than 5% of patients.

Your Child's Best Friend: TV or Not TV

Stiehm and I have been colleagues and friends for a long time, dating back to the golden days at Philadelphia (Pa) General Hospital, when we were both interns. We have authored a text together and dealt with similar issues in our research careers. Dick has been a valuable contributor to AJDC, offering his insightful critiques on articles, suggesting ways that the journal could be improved, soliciting state-of-the-art articles for us, and offering nonmedical observations that stimulate our readers to respond. His contribution at right continues this last-named tradition. Dick is one of the most respected pediatric immunologists in the world. He is regarded as an expert in many areas, and his work has influenced the use of immunoglobulin therapy, particularly the newer intravenous preparations. He has contributed to our understanding of congenital and acquired immunodeficiencies, to our knowledge and use of vaccines, and to the unraveling of basic immunologic