Intravenous immune globulin in primary immunodeficiency.

The development of safe and effective intravenous preparations of immune globulin (IVIG) represents a major advance in the treatment of patients with severe antibody deficiencies. Such therapy is expensive, few trials have been performed to compare one type of IVIG preparation with another under equivalent conditions, and published studies have been of relatively short duration. The overall consensus is that high-dose IVIG (at least 400/mg/kg/month) is superior to lower doses and most clinicians aim to maintain trough IgG levels above an arbitrary level of 5 g/l. Adverse reactions, usually mild, are common in antibody-deficient patients during the first few infusions, but severe, anaphylactoid reactions are extremely rare other than in patients with antibodies to IgA. IVIG is not associated with transmission of human immunodeficiency virus or hepatitis B, but there remains a small but definite risk of transmission of non-A, non-B hepatitis, including hepatitis C. Self-infusion of IVIG in the patient's home is a realistic alternative to hospitalization. In the UK, guidelines for home therapy have been approved by professional medical bodies and by the Department of Health. Home therapy has proven to be both safe and cost-effective.