Rapid desensitization to intravenous immunoglobulins
Itziar Eusebio Cartagena (Madrid, Spain), Maria G-Viciana (Madrid, Spain), Cristina Juarez Rodriguez (Madrid, Spain), Maria Eduarda Paixao (Madrid, Spain), Beatriz Moya (Madrid, Spain), Ruth Barranco (Madrid, Spain), Ruth Mielgo (Madrid, Spain)
Background

Intravenous immunoglobulins (IVIGs) have been extensively used as a replacement therapy in primary and selected secondary immunodeficiency diseases. IVIGs are an effective therapy for neurological diseases including Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy.

There are scarce reports of desensitizations performed on patients with hypersensitivity reactions to IVIGs.

Method

Throughout a period of 6 years, 4 patients were referred for an immediate adverse reaction to IVIG to the Department of Allergy at Hospital 12 de Octubre. Prior to the allergy workup, written informed consent were obtained. The evaluation included clinical history, skin testing and the desensitization procedure. Skin tests included undiluted skin prick tests (SPTs) and intradermal tests (IDTs) at 1/1 and 1/10 dilutions with immunoglobulins. The desensitization procedure consisted of a 3-solution 12-step protocol with Plangamma®, Flebogamma® or Privigen®, administered at fixed intervals every 15 minutes until the target dose was reached.

Results

The initial adverse reactions reported were cutaneous symptoms (urticaria and erythema) in all patients, and hypotension in 1 patient. All SPTs performed were negative. Undiluted IDTs yielded a positive result with Plangamma® (50mg/ml) in 1, and Flebogamma® (50mg/ml) in 1 out of 4 patients. Desensitizations were performed in Patient #1 and Patient #2 to Plangamma®; in Patient #3 to Flebogamma®; and in Patient #4 to Privigen®. Patient #4 switched to Flebogamma® (after two administrations) due to the lack of supply of Privigen® (after performing negative SPT and IDTs). All desensitizations were tolerated and a total of 48 rapid desensitizations were successfully administered. 

Conclusion

A rapid desensitization procedure to IVIG has shown to be safe and effective in patients with a hypersensitivity reaction to immunoglobulins.

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