What is IVIG or Intravenous Immune Globulin?
IVIg is a plasma product formed by taking antibodies from about 20,000 donors and mixing them together. This purified plasma treatment contains antibodies collected from the plasma of healthy donors and purified through a special process so that the therapy is safe and effective. Most of the antibodies are of the IgG class of antibodies, also called immunoglobulin G or gamma globulin. IVIg has proven effective in several immune system disorders, including nearly all autoimmune conditions.

How does IVIG work?
For immune deficiency where the body does not make enough antibodies, IVIG supplies them. Patients with autoimmune disorders are deficient in antiidotype antibodies. IVIG has antiidotype antibodies and thus helps improve the patient’s condition. Antiidotype antibodies are normal antibodies which are produced in the absence of any antigen. They are capable of inactivating many different types of antigens. IVIg has a higher concentration of antiidotype antibodies.

How long does it take to a IVIG treatment to have a effect?
After IVIg infusion, patients may see a response in their disease within 24- 48 hours. Some patients will have to wait 3-4 weeks to see an effect after IVIg. In a few no effect may be seen following IVIg infusion. If 4-5 cycles of IVIg do not show any response then try a different approach like plasmapheresis, cytotoxic or immune suppressants. The NIH recommends that if no response is seen with IVIg infusions, then add steroids to the treatment plan.

Everyone is slightly different as it depends on how long has the disease process been going on. The sooner one treats the disease with IVIg the faster the response. No one can predict how a particular patient will respond to IVIg.

Why is IVIG so expensive?
IVIg is obtained from plasma, donors are paid then the plasma is sent to processing centers for mixing, antibody removal, chemical treatment and filtration to remove viruses. This is followed by the products to be freeze dried.

How is IVIG administered?
IVIG is given intravenously, which means through a needle directly into a vein. Your doctor will determine the correct dosage, based on a number of individual factors, including your weight, your condition, and how well the IVIG treats or prevents symptoms.

IVIG can be administered in a hospital outpatient unit, infusion center, or your home. A typical infusion takes 2-4 hours, although some patients may require:

• IV (Intravenous)
  An IV is inserted into patient for short term IV therapy one day or a long term PICC line; the medication is infused via an IV pump
• SQ Sub Cutaneous
  A small needle is placed in the skin usually at the abdomen
• IM Intramuscular
  A injection similar to a vaccination needle

Where is the IVIG treatment given?
IVIg can be given at home, in a doctor’s clinic or a hospital outpatient unit. Some patients have even taken this at work.

How often do patients get infusions?
Usually a dose of IVIg is 2 grams per kilogram is divided into five doses and 400mg/kg is infused daily for 5 days. (For the first time only) Some patient can tolerate consecutive days of IVIg. It is recommended that young women take this on alternate days. This is followed by a monthly infusion of IVIG at 400mg/kg. NIH recommends IVIG at 2g/kg/month for use in all autoimmune neurological disorders. Some doses and frequency may be tailored for diseases and by the physician based on the available research IVIG replaces antibodies the body should be making, but does not help the patient's own immune system make more, so repeat doses are needed, usually every 3 to 4 weeks. Since immunodeficiency patients aren't "cured" by IVIG, they can still contract an infection, but infections have been shown to be less frequent and less severe. A study showed that effective IVIG therapy significantly reduced patients' missed days at school or work and also reduced the length of time they used antibiotics. Patients who rely on IVIG generally need infusions throughout their lives.

Are all IVIGs the same?
There are some differences in IVIG brand formulas that may make one product more suitable for you than another, such as sugar content, IgA content, sodium content, and use of latex or preservatives. Your doctor can help you determine which brand is best for you.

What are the common side effects OF IVIG?
Sometimes patients get a headache after IVIg which is more common in females with a history of Migraines or SLE. Patients may experience fatigue similar to getting a Flu, which is due to antibodies interaction. Some patients get a rash after IVIg and it is recommended they take Benadryl or even steroids to avoid this. Remember their are a lot of antibodies in IVIg and some may result in odd reactions. After IVIg if odd symptoms are seen then use of steroids usually helps. Some people experience changes in blood pressure and others may have a severe headache called aseptic meningitis.

How can one reduce the side effects of IVIG?
Remember to drink eight glasses of water a day for hydration before starting the IVIG treatment and continuing this a month after the last IVIg infusion. Also remember to take a baby aspirin to prevent thrombophelebitis after IVIg. Patients need to check with their doctors if they can use aspirin and should not take this if they are on Coumadin or have bleeding disorders. Doctors do not recommend that you use this if you have a history of stomach ulcers. Doctors use Premedication to help reduce side effects. Some recommend that one should take Tylenol or other NSAID for prevention of headaches and pains after IVIg. Physicians may use a Benadryl capsule for a rash and even to relax during the treatment. Physicians may use low dose prednisone will reduce side effects like headaches.

Can infections be transferred from IVIG?
No cases of infection have been reported since the year 2000. IVIG had been involved in the spread of some cases, then FDA took steps and IVIg producers followed instructions and no further cases of infection have been reported since the year 2000.

What are the differences in brands of IVIG?
Generally the difference is in IVIg is the amount of IgA content and also if the IVIg contains sucrose, glucose or some other sugar. Some IVIg products have Glycine while another one has no preservatives. Different IVIg products match different patients. In general all the products work about the same.

What is the right IVIG product for me?
Patients need to understand the differences among the IVIg products, and many factors need to be taken into consideration when deciding which IVIG product should be prescribed. Some examples of the factors include:

• Patients with congestive heart failure or compromised renal function may fare better if they receive a IVIg product with a low osmolality and low volume;
• Patients who are diabetic should receive a IVIg product containing no sugars;
• Patients receiving IVIg with sucrose may be at a higher risk for renal failure; (Need adjustment of concentration). Also patients who have Myositis and high myoglobin levels are at higher risk of developing renal failure while on IVIg infusion.
• Patients with immunoglobulin A (IgA) deficiencies should only receive products with the lowest amount of IgA or they could have anaphylactic reactions;
• Patients with small peripheral vascular access or a tendency toward phlebitis may want to avoid IVIg preparations with a low pH.

What are the most common brands of IVIG?
View listing of common brands of IVIG.

What diseases is IVIG being used for?
Some of the common autoimmune diseases include Alzheimer's, Narcolepsy, Multiple Sclerosis, Heart Disease, Lupus, forms of encephalitis, CIDP, autism, Transverse Myelitis, Brachial neuritis, Fibromyalgia and Chronic Fatigue Syndrome. (studies are available which show IVIg is effective in these conditions). If you need more info then go the the main page of IVIg on the CIDPUSA web site There you will find links to other pages providing all the details of IVIg.

What diseases is IVIG approved for use by FDA? (MEANS YOUR INSURANCE CANNOT DENY THIS IVIG TREATMENT)
The US Food and Drug Administration has approved the use of IVIG for the following 6 conditions:

• Primary immunodeficiencies IVIg is approved by FDA
• Immune-mediated thrombocytopenia IVIg is approved by FDA
• Kawasaki disease IVIg is approved by FDA
• Hematopoietic stem cell transplantation in patients older than 20 years (Gamimune-N only) IVIg is approved by FDA
• Chronic B-cell lymphocytic leukemia IVIg is approved by FDA
• Pediatric HIV type 1 infection IVIg is approved by FDA

What other conditions can IVIg be used for?

• Aplastic anemia is treated with IVIg
• Pure red cell aplasia is treated with IVIg
• Diamond-Blackfan anemia is treated with IVIg
• Autoimmune hemolytic anemia is treated with IVIg
• Hemolytic disease of the newborn is treated with IVIg
• Acquired factor VIII inhibitors is treated with IVIg
• Acquired von Willebrand disease is treated with IVIg
• Immune-mediated neutropenia is treated with IVIg
• Refractoriness to platelet transfusion is treated with IVIg
• Neonatal alloimmune/autoimmune thrombocytopenia is treated with IVIg
• Posttransfusion purpura is treated with IVIg
• Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome is treated with IVIg
• IVIg is used insolid organ transplantation, surgery, trauma, burns, and HIV infection.
• Epilepsy is treated with IVIg
• IVIg is used in Chronic inflammatory demyelinating polyneuropathy and Guillain-Barré syndrome
• Myasthenia gravis is treated with IVIg
• Lambert-Eaton myasthenic syndrome is treated with IVIg
• Multifocal motor neuropathy is treated with IVIg
• Multiple sclerosis is treated with IVIg
• Wegener granulomatosis: is treated with IVIg
• IVIG is used for recurrent pregnancy loss.
• Asthma is treated with IVIg
• Rheumatoid arthritis is treated with IVIg
• Systemic lupus erythematosus is treated with IVIg
• Systemic vasculitis treated with IVIg
• Dermatomyositis, polymyositis are treated with IVIg
• Inclusion-body myositis is treated with IVIg
• Amyotrophic lateral sclerosis is treated with IVIg
• Behçet syndrome is treated with IVIg
• Acute cardiomyopathy is treated with IVIg
• Chronic fatigue syndrome is treated with IVIg
• Congential heart block is treated with IVIg
• Cystic fibrosis is treated with IVIg
• Autoimmune blistering dermatosis is treated with IVIg
• Diabetes mellitus is treated with IVIg
• Acute idiopathic dysautonomia is treated with IVIg
• Acute disseminated encephalomyelitis is treated with IVIg
• Endotoxemia of Pregnanacy is treated with IVIg
• Hemolytic transfusion reaction is treated with IVIg
• Hemophagocytic syndrome is treated with IVIg
• Acute lymphoblastic leukemia is treated with IVIg
• Lower motor neuron syndrome is treated with IVIg
• Multiple myeloma is treated with IVIg
• Human T-cell lymphotrophic virus-1–associated myelopathy are treated with IVIg
• Nephritic syndrome is treated with IVIg
• Membranous nephropathy is treated with IVIg
• Nephrotic syndrome is treated with IVIg
• Euthyroid ophthalmopathy is treated with IVIg
• Opsoclonus-myoclonus is treated with IVIg
• Recurrent otitis media is treated with IVIg
• Paraneoplastic cerebellar degeneration is treated with IVIg
• Paraproteinemic neuropathy is treated with IVIg
• Parvovirus infection is treated with IVIg
• Polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome
• Progressive lumbosacral plexopathy is treated with IVIg
• Lyme radiculoneuritis is treated with IVIg
• Rasmussen syndrome is treated with IVIg
• Reiter syndrome is treated with IVIg
• Acute renal failure is treated with IVIg
• Thrombocytopenia is treated with IVIg
• Streptococcal toxic shock syndrome is treated with IVIg
• Uveitis is treated with IVIg
• Vogt-Koyanagi-Harada syndrome is treated with IVIg