ABSTRACT
ADVERSE REACTIONS TO INTRAVENOUS GAMMAGLOBULIN Anaphylactic and Anaphylactoid Reactions Although the safety and risks of IVIG are discussed elsewhere in this volume, some problems are particularly relevant to patients with immune deficiency diseases. Soon after attempts were made to administer gammaglobulin inttavenously, it became apparent that immune deficiency patients were more susceptible to anaphylactoid or phlogistic reactions. Barandun and his colleagues diluted the 16% ISG 10-fold and infused it into normal volunteers and patients with a variety of immunodeficiency diseases (15). Fortyeight of 55 normal volunteers tolerated the infusions given over a 90-to 120-min period. Under the same conditions 14 of 15 immunodeficient patients experienced early signs of flushing, nausea, and shivering, followed by a rise in temperature to 38 or 39°C. Two of the patients suffered more severe, anaphylactoid reactions. When the infusions were discontinued until the reactions subsided, the patients were able to tolerate infusions of the remainder of the gammaglobulin without further reactions. In some as yet unexplained manner the patients were desensitized by the reaction. Barandun believed that the IgG was spontaneously fixing complement and releasing mediators to cause the reactions. Treatment of the gammaglobulin with enzymes, ulttacentrifugation, or low pH to reduce the anticomplementary activity reduced but did not eliminate the reactions.
