by Carla Schick
Many patients who use either intravenous immunoglobulin (IVIG) or subcutaneous IG (SCIG) therapy to control their conditions are familiar with the occasional side effects that accompany their infusions. All medications come with adverse reactions that, although unwanted, are not surprising. And IVIG is no exception. But patients understand that while the side effects are by no means easy to tolerate, the benefits of their infusions far outweigh the consequences of mild to moderate side effects.
The good news is that most if not all side effects can either be treated or eliminated. Knowing what side effects, from mild to severe, to watch for during and after immune globulin infusions can help patients and their caregivers anticipate treatment changes to alleviate or halt a negative outcome.
Mild to Moderate Side Effects
Mild to moderate side effects usually occur because of the way in which the therapy is administered, and those can easily be managed. Adverse reactions from IVIG infusions can include headache, chills, flushing, myalgia, wheezing, tachycardia, lower back pain, nausea and hypotension. More severe headaches can include migraines.
An IG Living magazine article titled "Understanding and Treating IG Side Effects" by Ronale Tucker Rhodes and Kris McFalls mentions that patients can overcome headaches and migraines by treating with antihistamines, non-steroidal anti-inflammatory drugs (NSAIDs) and steroids both before and after an infusion, as well as by hydrating before, during and after an infusion.
Other treatment options are also available. In another IG Living article titled "Side Effects of IG," authors Kris McFalls and Nancy Creadon suggest that most patients experiencing these side effects can be helped by slowing down the rate of infusion. For instance, one patient who suffered from migraines after her infusions was prescribed a small dose of prednisone by her physician to be taken the day before the infusion, the day of the infusion and the day after the infusion. In addition, the rate of her infusion also was decreased. With these adjustments, the patient still experienced mild headaches, but she no longer suffered debilitating migraines.
Another patient who experienced severe migraines after IVIG infusions was given Tylenol, Benadryl and steroids, as well as a migraine prophylaxis prior to her infusions to lessen her side effects, but the headaches continued. Her doctor tried a 5% IVIG formulation and then a 10% formulation, but the migraines persisted. The patient was then switched to SCIG, which successfully stopped her recurring migraines, and no premedications were required.
SCIG patients can also experience side effects including headaches, redness, swelling, itching and blanching at the needles sites. But these usually diminish as the body becomes accustomed to the treatment. Using a topical anesthetic cream 30 to 60 minutes prior to beginning the infusion can be beneficial. Also, applying ice or heat to the needle sites can provide comfort to local irritation. However, if a needle is not inserted properly, it is possible that some of the fluid can leak into the surrounding tissue rather than into the subcutaneous space. If this is the case, then a provider trained in SCIG therapy should be able to help the patient find the source of irritation and eliminate possible causes.
Severe Side Effects
Thankfully, severe side effects are uncommon and most can be reduced by testing the patient for factors predisposing them to complications. Severe side effects can include acute renal failure, thrombosis, Stevens-Johnson syndrome, serum sickness, aseptic meningitis and anaphylaxis. The most serious IG-related headache comes from aseptic meningitis, which can cause severe headache, photo sensitivity, chills, nausea, vomiting, fever and/or painful eye movement. To prevent or lessen the effects of aseptic meningitis, the prescribing physician may recommend antihistamines, NSAIDS and steroids both before and after an infusion.
Anaphylaxis, another rare severe side effect, is a rapidly progressing, life-threatening allergic reaction that can be caused by either IVIG or SCIG infusions. Anaphylaxis may require the administration of corticosteroids and antihistamines, and in very severe cases, administration of epinephrine.
There are two types of anaphylaxis reactions: anaphylactic and anaphylactoid. According to the article "Understanding and Treating IG Side Effects," an anaphylactic reaction is an acute fatal, or potentially fatal, hypersensitivity reaction that requires the patient to be sensitized and their reaction mediated through immunoglobulin E (IgE) antibodies. An anaphylactoid reaction doesn't need the presence of IgE antibodies for a hypersensitivity reaction to occur. Thus, an anaphylactic reaction occurs only after the patient has been previously exposed at least once to the antigen and is sensitized. Although anaphylactic and anaphylactoid reactions are extremely rare, they can happen to any patient at any time. Fortunately, many patients who have experienced anaphylaxis have had improved results by switching from IVIG infusions to SCIG therapy.
Side effects come with all medications, including immune globulin therapy. The trick is to know how to manage the side effects before they start to manage you.
To learn more about the information found in this blog, read the IG Living articles Understanding and Treating IG Side Effects and Side Effects of IG.
What have been your experiences with side effects and how did you treat them?