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Intravenous immunoglobulin (IVIG) is a pooled antibody, and a biological agent used to manage various immunodeficiency states and a plethora of other conditions, including autoimmune, infectious, and inflammatory states. The ultimate goal of this therapy is to normalize a compromised immune system. This activity reviews the indications, mechanism of action, contraindications, adverse effects, and monitoring of IVIG in the treatment of several immune deregulated states. It also highlights the key information pertinent to the healthcare teams managing patients with conditions affecting the immune system and other immune-related conditions. Objectives: Identify the mechanism of action of intravenous immunoglobulin. Describe the potential adverse effects of intravenous immunoglobulin. Review the appropriate monitoring during therapy with intravenous immunoglobulin. Explain the inter-professional team strategies for improving care coordination and communication to advance treatment with intravenous immunoglobulin and improve outcomes. Access free multiple choice questions on this topic.

Various stringent quality-control measures are employed to ensure the safety of a typical IVIG product, which includes virus inactivation, removal of coagulation factors, and depletion of IgG aggregates. Though IVIG is generally considered to be a safe, well-tolerated, and efficacious therapeutic modality, reports exist in the literature of reported toxicities.[22] There are reports of renal toxicity with sucrose-containing products in patients greater than or equal to 65 years, patients receiving concomitant nephrotoxic agents, patients with diabetes mellitus, and those with pre-existing renal disease, hypovolemia, and sepsis. These patients are all at increased risk for acute renal failure and renal insufficiency.[86] Urine output, blood urea nitrogen, and creatinine require assessment in patients with an increased risk of developing acute renal failure. There is also a report of cardiac toxicity after IVIG therapy in a patient with scleromyxedema, which resulted in myocardial infarction.[87] Hematological toxicities, including various cytopenias and thrombotic complications, have also been reported and should be considered in patients with an increased risk of thrombosis.[88]

The onus for IVIG therapy's success lies mainly in the treating clinician to achieve treatment goals, as every patient needs a unique and tailored infusion regime. The first and primary means of achieving this is by having a correct diagnosis, and this occurs through efficient interprofessional communication between specialists. More often than not, the diagnosis may fall into the category where off-label use of IVIG is required (as evidenced by a large number of such conditions), and assessing the appropriateness of IVIG therapy must be balanced against the morbidity of the condition. Clinicians and other providers can accomplish this by staying up-to-date on the current guidelines from the authorities, such as the American Academy of Allergy, Asthma & Immunology, the European Academy of Allergy and Clinical Immunology, and the World Allergy Organization. Recently available scientific evidence of IVIG use in specific disease trials or studies should always be used along with the clinician's experience to guide the decision on dosage, targeted optimal IgG levels, choice of IVIG product, and course of treatment and should be modified in a patient-centric setting. The choice of IVIG products needs special attention as the products are not generic, and only one particular product, but not the other, may meet the patient's needs.

The onus for IVIG therapy's success lies mainly in the treating clinician to achieve treatment goals, as every patient needs a unique and tailored infusion regime. The first and primary means of achieving this is by having a correct diagnosis, and this occurs through efficient interprofessional communication between specialists. More often than not, the diagnosis may fall into the category where off-label use of IVIG is required (as evidenced by a large number of such conditions), and assessing the appropriateness of IVIG therapy must be balanced against the morbidity of the condition. Clinicians and other providers can accomplish this by staying up-to-date on the current guidelines from the authorities, such as the American Academy of Allergy, Asthma & Immunology, the European Academy of Allergy and Clinical Immunology, and the World Allergy Organization. Recently available scientific evidence of IVIG use in specific disease trials or studies should always be used along with the clinician's experience to guide the decision on dosage, targeted optimal IgG levels, choice of IVIG product, and course of treatment and should be modified in a patient-centric setting. The choice of IVIG products needs special attention as the products are not generic, and only one particular product, but not the other, may meet the patient's needs. IVIG therapy is a consistently evolving practice. More large-scale clinical trials are needed to assess the efficacy of treatment in specific conditions that may not be feasible in other rare conditions. In such situations, a treating clinician is responsible for publishing individual case studies and being part of a collective framework in establishing guidelines for IVIG therapy. Nurses play an evident role in patient care during IVIG infusion and promptly report any adverse reaction to the clinical team to tackle the situation immediately. The government and health authorities can influence the type of product approved in the local market and serve a fundamental role. The cost of IVIG and its availability in low and middle-income countries is challenging, and governmental/national measures to reduce the costs will bring IVIG therapy to the doorstep of the poor. Finally, the hospital authorities must be well-equipped to handle the transfusion and play a role in establishing standard IVIG protocols for well-established diseases. The hospital's research office should encourage more projects to address off-label use in rare conditions. With appropriate interprofessional teamwork involving clinicians (MDs, DOs, PAs, and NPs), specialists, nurses, and pharmacists, IVIG therapy can produce better patient outcomes, be expanded to cover more conditions, and result in fewer adverse events. [Level 5]