ABSTRACT
METHODS OF ADMINISTRATION Alternative Methods of Administration Until the early 1980s in the United States, the only form of IgG that was available for clinical use was given intramuscularly. The amount given was limited by pain, and the amount absorbed was reduced by proteolysis. Plasma therapy was used as an alterna-
tiv~ (75). Plasma had the theoretical benefit of providing IgA and lgM as well as the IgG, but the short half-life of those severely limited the degree of replacement. The amount of plasma that could be infused limited the ability to give large quantities of IgG, but the major problem with plasma therapy was the transmission of hepatitis. Thus, alternatives were sought that would allow large quantities of IgG to be given safely. In 1980 Berger and co-workers reported the use of a pump to give large quantities of immune serum globulin subcutaneously (76). Patients infused themselves at home, usually overnight. Patients achieved higher levels of IgG with fewer side effects and had fewer infections (76,77). Although subcutaneous infusion has been largely supplanted by IVIG, it remains a viable alternative for the rare patient who cannot tolerate IVIG or, since it allows the use of the less expensive immune serum globulin, for patients who cannot afford IVIG.
