Polyclonal Immunoglobulins and Hyperimmune Globulins in Prevention and Management of Infectious Diseases

https://doi.org/10.1016/j.idc.2011.07.005Get rights and content

Section snippets

Sepsis

Because of the high mortality associated with bacterial sepsis, there has long been interest in understanding and developing treatments adjunctive to antibiotics, such as IVIG. Mechanisms for a possible benefit of IVIG in sepsis include enhanced bactericidal activity through opsonizing immunoglobulin (Ig)G and IgM antibodies, stimulation of phagocytosis, and neutralization of bacterial toxins.7, 8 IVIG may also suppress the release of proinflammatory cytokines from endotoxin- or

Cytomegalovirus Infection in Solid Organ Transplant

Neutralizing antibodies are thought to play a role in the immune response that controls CMV infection and, therefore, interest has risen in the use of immunoglobulins as a prophylaxis and adjunctive therapy for CMV in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Both IVIG, containing a high titer of anti-CMV antibodies from healthy blood donors, and CMV hyperimmune globulin (CMV-Ig; CytoGam) have been used for the prevention of CMV disease, although

Adverse effects

Immunoglobulin therapy is complex and the incidence of adverse reactions is high. One previous study showed 440 of 1000 patients with primary immunodeficiency reported adverse effects that were not related to the rate of infusion.5 These adverse effects are typically mild and nonanaphylactic, including back or abdominal pain, nausea, rhinitis, asthma, chills, fever, myalgia, or headache. Additionally, many of these reactions can be reversed by slowing the infusion or with the use of steroids

Route of administration

Outside of the specific examination of oral Ig therapy in gastrointestinal infections with rotavirus, Campylobacter jejuni, and C difficile, intravenous Ig has been the primary route of administration.84, 85 More recently, subcutaneous infusion of Ig has been investigated as an alternative given the improved side-effect profile and enhanced levels of IgG in the blood.86 However, data exist for use in primary immunodeficiency only at this point. It is unclear if there is equivalent activity

Summary

The spectrum of IVIG use in the prevention and treatment of infectious disease is broad and particularly focuses on areas where disease is life threatening and effective treatment options are limited. The evidence for common uses of IVIG in infectious disease is summarized in Tables 2 and 3. In summary, limited data are available to guide therapy in the most infectious diseases. Although a great need for additional research exists, particularly focusing on randomized and controlled trials,

First page preview

First page preview
Click to open first page preview
View PDF

References (89)

  • V. Hammarstrom et al.

    Oral immunoglobulin treatment in Campylobacter jejuni enteritis

    Lancet

    (1993)
  • L. Mouthon et al.

    Intravenous immunoglobulins in autoimmune- or parvovirus B19-mediated pure red-cell aplasia

    Autoimmun Rev

    (2005)
  • I. Krause et al.

    In vitro antiviral and antibacterial activity of commercial intravenous immunoglobulin preparations–a potential role for adjuvant intravenous immunoglobulin therapy in infectious diseases

    Transfus Med

    (2002)
  • A. Durandy et al.

    Intravenous immunoglobulins–understanding properties and mechanisms

    Clin Exp Immunol

    (2009)
  • H. Leong et al.

    Unlabeled uses of intravenous immune globulin

    Am J Health Syst Pharm

    (2008)
  • K. Darabi et al.

    Current usage of intravenous immune globulin and the rationale behind it: the Massachusetts General Hospital data and a review of the literature

    Transfusion

    (2006)
  • S. Sriskandan et al.

    Human intravenous immunoglobulin for experimental streptococcal toxic shock: bacterial clearance and modulation of inflammation

    J Antimicrob Chemother

    (2006)
  • K. Werdan

    Pathophysiology of septic shock and multiple organ dysfunction syndrome and various therapeutic approaches with special emphasis on immunoglobulins

    Ther Apher

    (2001)
  • K.G. Kreymann et al.

    Use of polyclonal immunoglobulins as adjunctive therapy for sepsis or septic shock

    Crit Care Med

    (2007)
  • A.F. Turgeon et al.

    Meta-analysis: intravenous immunoglobulin in critically ill adult patients with sepsis

    Ann Intern Med

    (2007)
  • K.B. Laupland et al.

    Polyclonal intravenous immunoglobulin for the treatment of severe sepsis and septic shock in critically ill adults: a systematic review and meta-analysis

    Crit Care Med

    (2007)
  • M.M. Alejandria et al.

    Intravenous immunoglobulin for treating sepsis and septic shock

    Cochrane Database Syst Rev

    (2002)
  • A. Rodriguez et al.

    Effects of high-dose of intravenous immunoglobulin and antibiotics on survival for severe sepsis undergoing surgery

    Shock

    (2005)
  • A. Sablotzki et al.

    Treatment of sepsis in cardiac surgery: role of immunoglobulins

    Perfusion

    (2001)
  • W. Barry et al.

    Intravenous immunoglobulin therapy for toxic shock syndrome

    JAMA

    (1992)
  • R. Kaul et al.

    Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome–a comparative observational study. The Canadian Streptococcal Study Group

    Clin Infect Dis

    (1999)
  • D.L. Stevens

    Rationale for the use of intravenous gamma globulin in the treatment of streptococcal toxic shock syndrome

    Clin Infect Dis

    (1998)
  • J. Darenberg et al.

    Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double-blind, placebo-controlled trial

    Clin Infect Dis

    (2003)
  • S.S. Shah et al.

    Intravenous immunoglobulin in children with streptococcal toxic shock syndrome

    Clin Infect Dis

    (2009)
  • J. Darenberg et al.

    Differences in potency of intravenous polyspecific immunoglobulin G against streptococcal and staphylococcal superantigens: implications for therapy of toxic shock syndrome

    Clin Infect Dis

    (2004)
  • L.K. Archibald et al.

    Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987-2001

    J Infect Dis

    (2004)
  • A. Fernandez et al.

    Factors associated with failure of metronidazole in Clostridium difficile-associated disease

    J Clin Gastroenterol

    (2004)
  • L. Kyne et al.

    Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile

    Clin Infect Dis

    (2002)
  • P.H. Kim et al.

    Immunization of adult hamsters against Clostridium difficile-associated ileocecitis and transfer of protection to infant hamsters

    Infect Immun

    (1987)
  • D.M. Lyerly et al.

    Passive immunization of hamsters against disease caused by Clostridium difficile by use of bovine immunoglobulin G concentrate

    Infect Immun

    (1991)
  • D.N. Gerding et al.

    Management of Clostridium difficile infection: thinking inside and outside the box

    Clin Infect Dis

    (2010)
  • L. Kyne et al.

    Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A

    N Engl J Med

    (2000)
  • M.S. Abougergi et al.

    Intravenous immunoglobulin for the treatment of Clostridium difficile infection: a review

    Dig Dis Sci

    (2011)
  • J. Salcedo et al.

    Intravenous immunoglobulin therapy for severe Clostridium difficile colitis

    Gut

    (1997)
  • I. Lowy et al.

    Treatment with monoclonal antibodies against Clostridium difficile toxins

    N Engl J Med

    (2010)
  • K. Kretsinger et al.

    Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel

    MMWR Recomm Rep

    (2006)
  • Centers for Disease Control and Prevention (CDC)

    Tetanus surveillance—United States, 2001–2008

    MMWR Morb Mortal Wkly Rep

    (2011)
  • M. Afshar et al.

    Narrative review: tetanus–a health threat after natural disasters in developing countries

    Ann Intern Med

    (2011)
  • M.A. Keller et al.

    Passive immunity in prevention and treatment of infectious diseases

    Clin Microbiol Rev

    (2000)

    • Cited by (0)

    The authors have nothing to disclose.

    View full text
    Copyright © 2011 Published by Elsevier Inc.