Side effects of treatment of hypogammaglobulinaemia with gammaglobulin

Home treatment of hypogammaglobulinaemia with subcutaneous gammaglobulin by rapid infusion

Intramuscular and intravenous gammaglobulin treatment for hypogammaglobulinaemia is often associated with systemic adverse reactions in some patients. Subcutaneous infusions of gammaglobulin are usually given at a slow rate. To assess the safety of home treatment with subcutaneous gammaglobulin, rapid infusions (34-40 ml/h) given by small portable pumps were used to treat twenty-five patients with hypogammaglobulinaemia. Fifteen patients had previously had adverse reactions to intramuscular or intravenous gammaglobulin treatment. After the patients had been taught how to use the pumps during 6 months of treatment in hospital, in which they initially received 100 mg of an intramuscular gammaglobulin preparation/kg per week, they went on to use the pumps at home or at work. So far, the patients have given themselves 3232 rapid subcutaneous infusions (2308 in home therapy). A median pre-infusion serum IgG concentration of 8.1 g/l resulted after 6 months of treatment. There were only 30 (0.93%) mild systemic adverse reactions; there were fewer reactions with subcutaneous gammaglobulin than with previously given intramuscular injections (n = 21, p less than 0.001) or intravenous infusions (n = 9, p less than 0.001) in this group of patients. Overall, the patients spent 0.2 days a year in hospital due to respiratory tract infections. The findings show that the method for subcutaneous administration is very easy to learn and is appreciated by the patients; moreover, the infusions can be given much faster than previously reported without any pronounced local reaction.

Intravenous gamma-globulin infusions in patients with hypo-gamma-globulinemia: prevention of adverse reactions with corticosteroids

A gamma-globulin preparation for intravenous use was given to 11 patients with antibody deficiency syndromes. Most of them had reacted earlier to intramuscular injections of normal gamma-globulin. The gamma-globulin employed produced adverse reactions, often quite severe in 8 of 9 intravenous infusions in three patients. After premedication with hydrocortisone, side effects appeared on 18 of 48 occasions in 10 patients, but only twice were they so severe that the infusions had to be interrupted. Thus, it seems that hydrocortisone diminishes the risk of side effects. The intravenously administered gamma-globulin seemed to be just as effective as the preparations for intramuscular use, and no severe infections appeared during the period of observation. There was no indication that the single hydrocortisone injections, usually 200 mg, increased the risk of contracting infections, but still such medication should be used with great caution in antibody-deficient patients.