Intravenous Immunoglobulin (IVIg) in the treatment of acute and chronic neurological diseases

What is intravenous immunoglobulin (IVIg)?

IVIg is a blood product made from pooled plasma from many different people. Plasma is the clear fluid part of our blood. Immunoglobulins are proteins produced by the immune system ( the body's defence system). This protein is removed form the plasma and added to a solution which is used to treat your condition.

What is it used for?

IVIg is recommended for use in Guillain-Barré syndrome, multifocal motor neuropathy and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). It can be useful in other neuromuscular conditions.  Please be aware that IVIg might not have a licence for the problem your doctor has recommended this treatment.

How does it work?

The way IVIg works in these rare condition is not fully understood. What we do know is it can help to calm down some inflammatory processes that affect muscle and nerve function. It probably blocks harmful antibodies and other immunological factors produced by the patient’s own immune system.

How is It given?

IVIg is given by injection into a vein through an infusion pump, the rate, dose and time is individualised for each patient. The first treatment is usually given over 3-5 days. If the treatment is successful it may need to be repeated several times or possibly long term. IVIg is given in hospital, usually on a day unit.

What are the possible side effects?

As with all treatments side effects can occur with IVIg. These are usually mild and do not affect your treatment. Common short-lived side effects such as flushing, fever, shivering, muscles aches, sickness and headaches usually respond to slowing down the rate of infusion. It is important to be well hydrated; paracetamol can be given as applicable. You will be given the same brand ofIVIg each visit. Occasionally people may develop a rash or low blood pressure and severe headache the day after treatment is common. You will be monitored during your treatment, but do report new symptoms during or after treatment. Less commonly a more severe rash may develop that may be blistering, painful and last for weeks.  Rarely there may be more serious side effects which including allergic reactions (including anaemia), kidney failure, heart attack, stroke or venous blood clots. IVIg thickens your blood slightly so particular caution is taken with people with a past history of vascular problems.  Although risks are small, you may wish to consider ways to reduce vascular risk, such as avoiding smoking or the combined oral contraceptive pill (not the progesterone only pill or ‘minipill’ , which is fine).

Are there any other risks from IVIg?

As IVIg is a blood product, after having it you cannot donate blood for the rest of your life.  It is screened for all known transmissible agents  (e.g. hepatitis B or C and HIV), but there could be other agents we have not discovered and despite stringent steps to avoid passing on infection there remains a remote theoretical risk. Variant Creutzfeldt-Jacob disease (vCJD) is a transmissible disease, but there is no evidence so far that it can be transmitted with IVIg.

Before the infusion

You will be required to consent to the IVIg treatment. The doctor or nurse will discuss this with you and  you will be required to sign a consent form. It is important that you are well hydrated throughout your treatment. Let the nurse know if you are pregnant, if you suffer from diabetes, kidney problems or have previously had an allergic reaction to IVIg or other drugs. Avoid furosemide (or other loop diuretics) on treatment days. Blood pressure, pulse and temperature will be monitored. You may be examined by the neuromuscular nurse before the first dose is given.

After the infusion

If you feel unwell in the days that follow your infusion with headache it should settle after a few days, but  if persistent or worsening see your GP who may need to arrange blood tests.  Some allergic reactions can be delayed, for example blistering rash or easy bruising, and you should discuss these with your GP. You will be asked to return to the hospital after 2-3 weeks  to assess your response to treatment.

Advisory Notices:

It is advised that  you should not fly long haul for 1 week following your IVIg treatment. Please be aware of this at the time of your treatment bookings.

There is a concern that vaccines may be less effective but are not contraindicated when having treatment with IVIg. Please check with your nurse if you have any concerns regarding vaccines.