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Adverse Events and Intravenous Immunoglobulin

Delayed adverse events occur frequently after IVIG in children.

Intravenous immunoglobulin (IVIG) is used in the treatment of inflammatory and immune-mediated disorders, such as Kawasaki disease and idiopathic thrombocytopenic purpura. In a prospective study, researchers assessed adverse events (AEs) occurring during (immediate AE) and after (delayed AE) infusion among 58 children (mean age, 4 years) who received a total of 345 infusions for immunodeficiency or immunomodulation.

Immediate AEs were observed and documented by nursing staff, and delayed AEs were reported during a follow-up interview 4 to 7 days after infusion. Significantly fewer patients had immediate AEs than delayed AEs (10% vs. 41%). Among a total of 84 AEs in 26 children, 12 were immediate and 72 were delayed. Pretreating patients with corticosteroids or antihistamines did not eliminate AEs. Headache, pain at the infusion site, and vertigo each occurred in 0.9% of immediate AEs, and palpitations and bronchospasm occurred in 0.6%. An immediate AE in one patient required cessation of therapy. Headache (12.8%) and fatigue (5.2%) were the most common delayed AEs, followed by abdominal pain, myalgia, and rash (each 2.3%). Most delayed headaches resolved within 24 hours, but seven episodes lasted longer and led to 8 missed school days overall. AEs were not associated with dose, speed of infusion, or type of immunoglobulin.

Comment: IVIG is being used with increasing frequency for inflammatory disorders. Pediatricians will be on the front line for managing many of these patients. Informing patients and their families about expected adverse symptoms and managing them prospectively will be important. Unfortunately, pretreatment with corticosteroids and antihistamines doesn’t eliminate adverse events, but they could reduce the severity of symptoms. Although other factors might have contributed to the delayed adverse events reported in this study, knowing that delayed events might occur is helpful.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine November 15, 2006

Citation(s):

Singh-Grewal D et al. A prospective study of the immediate and delayed adverse events following intravenous immunoglobulin infusions. Arch Dis Child 2006 Aug; 91:651-4.

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