Canadian Consensus Statement on the Use of Intravenous Immunoglobulin Therapy in Dermatology

2006 ◽  
Vol 10 (5) ◽  
pp. 205-221 ◽  
Author(s):  
P. Régine Mydlarski ◽  
Vincent Ho ◽  
Neil H. Shear
Keyword(s):  
Intravenous Immunoglobulin ◽  
Skin Disease ◽  
Consensus Statement ◽  
Case Series ◽  
Ivig Therapy ◽  
Stevens Johnson Syndrome ◽  
Mucous Membrane Pemphigoid ◽  
Pemphigus Foliaceus ◽  
Intravenous Immunoglobulin Therapy ◽  
Therapeutic Algorithms

Background: As a safe, well-tolerated, and potentially beneficial therapy, intravenous immunoglobulin (IVIG) has been increasingly used by dermatologists to treat immune-mediated skin disease. However, practical and comprehensive guidelines for the use of IVIG have yet to be established. Objective: To develop the first Canadian consensus statement on the use of IVIG therapy in skin disease. Methods: A group of Canadian dermatologists convened to discuss current issues in IVIG therapy. The participants reviewed and evaluated the literature and shared clinical experience. Using a modified Delphi process, a consensus statement was developed. Results: Herein we provide a brief overview of pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Recommendations for the management of these diseases are detailed, and therapeutic algorithms for the treatment of various autoimmune mucocutaneous blistering diseases are presented. The appropriate use of IVIG therapy is placed in context for each disease. Conclusion: Although preliminary data suggest that IVIG is a safe and effective therapy for many skin disorders, uncontrolled clinical trials, case series, and anecdotal case reports dominate the literature. Collaborative randomized controlled trials are required to firmly establish the role of IVIG in dermatology.

Frequency of Adverse Events Associated with Intravenous Immunoglobulin Therapy in Patients with Pemphigus or Pemphigoid

2007 ◽  
Vol 41 (10) ◽  
pp. 1604-1610 ◽  
Author(s):  
Hakan M Gürcan ◽  
A Razzaque Ahmed
Keyword(s):  
Adverse Effects ◽  
Adverse Events ◽  
Intravenous Immunoglobulin ◽  
Ivig Therapy ◽  
Biologic Agent ◽  
Mucous Membrane Pemphigoid ◽  
Pemphigus Foliaceus ◽  
Close Monitoring ◽  
Cervical Lymph Nodes ◽  
Intravenous Immunoglobulin Therapy

Background: Intravenous immunoglobulin (IVIG) therapy is widely used in immune-mediated diseases as an immunomodulatory agent and is considered to be a safe biologic agent. Objective: To determine the frequency of adverse events associated with IVIG therapy in patients with pemphigus and pemphigoid. Methods: We retrospectively reviewed data on patients treated with IVIG for pemphigus and pemphigoid over a 10 year period. Patients had pemphigus vulgaris, pemphigus foliaceus, mucous membrane pemphigoid, or bullous pemphigoid. IVIG was given according to a published protocol at a dose of 2 g/kg administered over 3–5 days at prescribed intervals. Patient records were reviewed for information on sex, age, duration of treatment, number of cycles given, number of days each patient received IVIG, weight of each patient, IVIG dose each patient received per infusion, and early or delayed adverse effects reported by patients or observed by healthcare providers. Results: We identified 9892 infusions given to 174 patients. Headaches were the most common adverse effects; they were observed during 886 (8.9%) infusions and involved 123 (70.6%) patients. The incidence of other minor adverse effects, including fatigue, nausea, vomiting, chills, urticaria, swollen glands, hoarseness, thoracic discomfort, and palpitations, was 0.57–3.4% per infusion and 0.04–1,3% per patient. Hoarseness of voice and swelling of cervical lymph nodes have not been previously reported. Acute renal failure occurred in one patient and was the only major adverse effect observed. None of the patients required hospitalization, and there were no deaths. Conclusions: Adverse events associated with IVIG therapy are usually mild and self-limiting. The incidence of serious adverse events is low. Identification of risk factors and close monitoring of high-risk patients throughout the therapy are likely to decrease the occurrence of rare serious and less likely fatal adverse effects.

scholarly journals Intravenous immunoglobulin therapy in COVID-19-related encephalopathy

2020 ◽  
Author(s):  
Lorenzo Muccioli ◽  
Umberto Pensato ◽  
Giorgia Bernabè ◽  
Lorenzo Ferri ◽  
Maria Tappatà ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Neuropsychiatric Symptoms ◽  
Brain Mri ◽  
Invasive Mechanical Ventilation ◽  
Case Series ◽  
Ivig Therapy ◽  
Immunoglobulin Therapy ◽  
Severe Respiratory Distress ◽  
Intravenous Immunoglobulin Therapy ◽  
Extrapyramidal Signs

Abstract Objective To report on efficacy and safety of intravenous immunoglobulin (IVIg) therapy in a case series of patients with COVID-19-related encephalopathy. Methods We retrospectively collected data on all patients with COVID-19 hospitalized at two Italian hospitals who developed encephalopathy during disease course and were treated with IVIg. Results Five patients (two females, mean age 66.8 years) developed encephalopathy after a mean of 12.6 days, since the onset of respiratory/constitutional symptoms related to COVID-19. Four patients suffered severe respiratory distress, three of which required invasive mechanical ventilation. Neurological manifestations included impaired consciousness, agitation, delirium, pyramidal and extrapyramidal signs. EEG demonstrated diffuse slowing in all patients. Brain MRI showed non-specific findings. CSF analysis revealed normal cell count and protein levels. In all subjects, RT-PCR for SARS-CoV-2 in CSF tested negative. IVIg at 0.4 g/kg/die was commenced 29.8 days (mean, range: 19–55 days) after encephalopathy onset, leading to complete electroclinical recovery in all patients, with an initial improvement of neuropsychiatric symptoms observed in 3.4 days (mean, range: 1–10 days). No adverse events related to IVIg were observed. Conclusions Our preliminary findings suggest that IVIg may represent a safe and effective treatment for COVID-19-associated encephalopathy. Clinical efficacy may be driven by the anti-inflammatory action of IVIg, associated with its anti-cytokine qualities.

scholarly journals Refractory Toxic Shock-Like Syndrome fromStreptococcus dysgalactiaessp.equisimilisand Intravenous Immunoglobulin as Salvage Therapy: A Case Series

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Marjan Islam ◽  
Dennis Karter ◽  
Jerry Altshuler ◽  
Diana Altshuler ◽  
David Schwartz ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Intravenous Immunoglobulin ◽  
Salvage Therapy ◽  
Adjunctive Therapy ◽  
Case Series ◽  
Ivig Therapy ◽  
Mortality Rates ◽  
Invasive Disease ◽  
Streptococcus Dysgalactiae ◽  
Toxic Shock

Infections fromStreptococcus dysgalactiaessp.equisimilis(SDSE) can cause a wide variety of infections, ranging from mild cellulitis to invasive disease, such as endocarditis and streptococcal toxic shock-like syndrome (TSLS). Despite prompt and appropriate antibiotics, mortality rates associated with shock have remained exceedingly high, prompting the need for adjunctive therapy. IVIG has been proposed as a possible adjunct, given its ability to neutralize a wide variety of superantigens and modulate a dysregulated inflammatory response. We present the first reported cases of successful IVIG therapy for reversing shock in the treatment of SDSE TSLS.

ACUTE CORONARY SYNDROME FOLLOWING INTRAVENOUS IMMUNOGLOBULIN THERAPY : A HIDDEN RISK

2021 ◽  
pp. 78-79
Author(s):  
Karthikkeyan Rajachandran ◽  
Giphy Susan Varghese
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Intravenous Immunoglobulin ◽  
Ivig Therapy ◽  
Immunoglobulin Therapy ◽  
Left Ventricular ◽  
Intravenous Immunoglobulin Therapy ◽  
Severe Left Ventricular Dysfunction ◽  
St Segment Elevation ◽  
Coronary Syndrome

Intravenous immunoglobulin (IVIG) is one of the main line modalities of therapy for chronic inammatory demyelinating polyneuropathy (CIDP). We hereby, report an incidence of acute myocardial infarction probably induced by IVIG during the treatment of CIDP. A 76 year old female with no history suggestive of cardiovascular disease, developed an acute Non ST Segment Elevation Myocardial Infarction (NSTEMI) and severe left ventricular dysfunction after receiving three doses of IVIG. Since hypercoagulability is a concern with IVIG therapy, it was discontinued. Hence, we highlight the importance of cardiac evaluation before initiation and during the course of IVIG therapy in elderly patients as well as in patients with known risk factors for cardiovascular disease and thrombotic events.

scholarly journals High-dose intravenous immunoglobulin therapy induces and maintains complete remission for polyarteritis nodosa

2014 ◽  
Vol 1 (1) ◽  
pp. 13
Author(s):  
Kazu Ode ◽  
Yoshinori Taniguchi ◽  
Yoshitaka Kumon ◽  
Yoshio Terada
Keyword(s):  
Complete Remission ◽  
Intravenous Immunoglobulin ◽  
Polyarteritis Nodosa ◽  
Alternative Therapy ◽  
Ivig Therapy ◽  
Immunoglobulin Therapy ◽  
High Dose ◽  
Intravenous Immunoglobulin Therapy ◽  
First Line Therapy ◽  
High Dose Ivig

We report a case of successful high-dose intravenous immunoglobulin (IVIG) use in a patient with refractory polyarteritis nodosa (PAN). Treatments with prednisolone (PSL) and various types of immunosuppressants including methotrexate (MTX) and intravenous cyclophosphamide (IVCY) were unsuccessful, and then, high-dose IVIG therapy was added. High-dose IVIG therapy improved all symptoms including high fever, arthralgia, mononeuritis multiplex and indurated erythema due to PAN. Moreover, serum inflammatory markers were also normalized. High-dose IVIG is maintaining complete remission for PAN without flare-up for additional 4 years. Therefore, high-dose IVIG therapy might be considered as a first-line therapy in patients with PAN or alternative therapy in refractory PAN.

scholarly journals A Case of Guillain-Barré Syndrome and Stevens-Johnson Syndrome/Toxic Epidermal Necrosis Overlap After Pembrolizumab Treatment

2021 ◽  
Vol 9 ◽  
pp. 232470962110374
Author(s):  
Tomoyo Oguri ◽  
Shinji Sasada ◽  
Satoko Shimizu ◽  
Risa Shigematsu ◽  
Yumi Tsuchiya ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Immunoglobulin Therapy ◽  
The Body ◽  
Guillain Barre Syndrome ◽  
Stevens Johnson Syndrome ◽  
Intravenous Immunoglobulin Therapy ◽  
Johnson Syndrome ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Epidermal Necrosis

A 76-year-old man was admitted to our hospital with Guillain-Barré syndrome (GBS), presenting with facial palsy, dysarthria, and dysphagia as Grade 3 immune-related adverse events (irAEs) due to pembrolizumab administration for Stage IV lung adenocarcinoma. Although prednisolone (1 mg/kg) was started for GBS due to the irAE, dark erythema and skin eruptions appeared on the patient’s torso. Then erosion was observed on 18% of the body surface area and skin biopsy was performed. Finally, the patient was diagnosed with Stevens-Johnson syndrome/toxic epidermal necrosis overlap. Intravenous immunoglobulin therapy was started, and the skin symptoms improved, with the erosion becoming epithelial. He died of aspiration pneumonia related to GBS, although his neurological symptoms had improved after steroid and intravenous immunoglobulin therapy. This is the first reported case of pembrolizumab-induced GBS and Stevens–Johnson syndrome/toxic epidermal necrosis overlap. It is necessary to be careful that the possibility of other severe irAEs may occur simultaneously.

Psoriasiform dermatitis following intravenous immunoglobulin therapy: A case series

2021 ◽  
Author(s):  
Tyler J. Willenbrink ◽  
India S. Robinson ◽  
Jessica S. Connett ◽  
Lara Wine Lee
Keyword(s):  
Intravenous Immunoglobulin ◽  
Case Series ◽  
Immunoglobulin Therapy ◽  
Intravenous Immunoglobulin Therapy
Sign in / Sign up

Export Citation Format

Share Document