Immune Globulin Injection: What You Need To Know

Immune globulin injections (IVIG and SCIG) are essential treatments for immune deficiencies and certain autoimmune conditions.

Key Takeaways

• Immune globulin (IVIG or SCIG) is a therapy made from human plasma that helps strengthen the immune system.
• It is commonly used to treat primary immunodeficiency and certain autoimmune or neurological conditions.
• IVIG is given intravenously (in the veins) less frequently, while SCIG is given subcutaneously (under the skin) and self-administered more often at home.
• Treatment is generally safe but may cause mild side effects like headache, fever, or fatigue.
• Regular monitoring is required to ensure effectiveness and adjust dosing.

What Is Immune Globulin?

Immune globulins, also called immunoglobulins, are proteins secreted by our white blood cells. Immunoglobulins are glycoproteins that act as antibodies that recognize antigens, such as bacteria or viruses, to help the immune system neutralize and eliminate them.

While babies initially receive immunoglobulins from their mothers through transplacental transfer, the levels may reduce with time, resulting in immunodeficiency. Immunoglobulin replacement therapy can help fight several infections and diseases that arise due to this deficiency. 

What Is Immune Globulin Injection?

Immunoglobulin injection is a blood product used to treat several infections in individuals who have a compromised immune system and are highly susceptible to multiple infections. This blood product is derived from pooled blood donations, where thousands of healthy blood donors donate their blood.

Immunoglobulins are typically used for infusion for long-term treatments such as primary immunodeficiency, inflammatory conditions, deficiency of a particular antibody, and several other secondary immune conditions.

Routes of Administration for Immunoglobulin Injection

Therapeutic immunoglobulin can be given via intravenous (IV) or subcutaneous (SC) route. The route of administration depends on the individual patient and the medical status of the patient. The choice depends on factors such as venous access, dose requirements, tolerability, and personal preference. Each route offers advantages and disadvantages.

One clear advantage of intravenous immunoglobulin (IVIG) over subcutaneous injection is that it can be infused in larger volumes. Therefore, the peak level is reached rapidly, and the immunoglobulin can be given less frequently. The IV route is preferred in patients who need high-dose treatment either during acute infection or for immunomodulating effects.

Newer IVIG preparations are generally associated with fewer infusion-related adverse effects because of improved manufacturing methods that remove immunoglobulin aggregates. However, intravenous immunoglobulin is still associated with more frequent systemic adverse effects than subcutaneous injections.

A subcutaneous infusion is preferred for patients with poor venous access, cardiac problems, renal failure, and patient independence. This injection can be self-administered or given by a partner without needing assistance from an infusion nurse. Thus, the advantages of subcutaneous immunoglobulin injection include improved quality of life, independence during the treatment, flexibility, and portability of the injection. 

What Is Immunoglobulin Injection Given for?

Immune globulin injection is primarily used as replacement therapy for individuals with antibody deficiencies. Its goal is to strengthen the immune system and reduce the frequency and severity of infections.

It is commonly used in:

• Primary immunodeficiency diseases (e.g., CVID, agammaglobulinemia)
• Specific antibody deficiency
• Secondary immunodeficiency (in select cases)

It is also used in certain autoimmune and inflammatory conditions, including:

• Chronic inflammatory demyelinating polyneuropathy (CIDP)
• Guillain-Barré syndrome
• Immune thrombocytopenic purpura (ITP)
• Kawasaki disease
• Myasthenia gravis
• Multifocal motor neuropathy

In many primary immunodeficiency conditions, treatment is lifelong. However, in some cases, such as transient or partial deficiencies, a trial of therapy may be sufficient.

Different Types of Immunoglobulins

The human body makes a few different types of immunoglobulin antibodies:

• Immunoglobulin A (IgA): IgA is present in the mucous membranes of the lungs, sinuses, stomach, and intestines. 
• Immunoglobulin G (IgG): This is the most common type of immunoglobulin antibody. It protects us from infection by “remembering” the disease-causing bacteria or virus that we have been exposed to earlier.
• Immunoglobulin M (IgM): These immunoglobulins are the first ones prepared by our bodies when we are exposed to a new kind of germ.
• Immunoglobulin E (IgE): These antibodies are produced against allergies.  
• Immunoglobulin D (IgD): These antibodies are present at very low levels (less than 1%). Their exact function is not known.  

How To Tell if Intravenous Immunoglobulin (IVIG) Is Working

Tracking your immunoglobulin blood levels and watching for the symptoms of diseases is the best way to know whether the treatment with immunoglobulin injection is working.

Doctors will evaluate patients for clinical improvements after the treatment is initiated. After the first three months of administering the immunoglobulin injection, it is necessary to monitor the immunoglobulin levels in the blood. If the patient has reached normal levels, the next monitoring can be scheduled after 6 to 12 months.

If the patient has conditions such as pregnancy, weight gain, frequent bacterial infections, or is entering puberty, the treatment needs to be modified. Your doctor will either shorten the interval between two injections or adjust the dose. Many times, doctors might suggest shifting to subcutaneous injections.

Immunoglobulin Injection Doses

Typical IVIG dosing ranges from 400 to 600 mg/kg per infusion, with treatments lasting 2 to 6 hours.

Infusions are started slowly (0.5 to 1 mg/kg/min) and gradually increased if tolerated. Slower infusion rates are often used in patients at higher risk of side effects, such as those with kidney disease or clotting risk.

The FDA recommends that infusion rates should be kept at 3 to 4 mg/kg/min in patients who are at risk of renal failure or thrombosis. Infusions can be administered via peripheral or central intravenous access. Some patients may need lifelong immunoglobulin treatment; however, in such cases, a central venous catheter or port-a-cath placement solely for infusing IVIG injection is not recommended because of the risks of infection and thrombosis. 

When switching from IVIG to SCIG, the first subcutaneous infusion is usually given 1 to 2 weeks after the last IV infusion, as described in most U.S. licensing studies. It takes 5 to 12 weeks to achieve a new, steady state when switching from IVIG to SCIG, initiating SCIG in a patient, or making a change in the weekly dosage. Typically, SCIG is administered weekly, but one 20% product was recently approved for administration at variable frequencies, including daily, weekly, or biweekly, providing even more flexible scheduling.

SCIG can be administered by gradual infusion or can be rapidly pushed into body sites where there is enough subcutaneous fat, such as the abdominal wall, inner thigh, posterior upper arm, flanks, or below the buttocks. The infusion can be given via one to six sites, depending on the total volume. Administration might take 30 to 90 minutes via infusion pump or 5 to 20 minutes via rapid push. Both methods are practical and well-tolerated.

At-Home Injections

Since subcutaneous immunoglobulin injections can be self-administered, the patient has the luxury of infusing while at home or traveling. 

In one study, IVIG was administered in the home setting for patients with multifocal motor neuropathy (MMN) and chronic inflammatory demyelinating polyradiculoneuropathy. Clinical trials on such patients have shown that this is a safe and effective option for patients requiring frequent IVIG doses.

Receiving IVIG in home-based settings is cost-effective compared to receiving the therapy in a hospital setting.

Side Effects of Immunoglobulin Injections

Immunoglobulin therapy is generally well tolerated, with most side effects being mild and temporary.

Common side effects:

• Flushing
• Headache
• Malaise
• Fever
• Chills
• Fatigue and lethargy
• Eczema
• Dermatitis
• Lowered blood pressure
• Increased heartbeat
• Nausea
• Diarrhea
• Bronchospasm
• Cough

Rare but serious side effects:

• Renal impairment
• Thrombosis
• Arrhythmia
• Aseptic meningitis
• Hemolytic anemia
• Transfusion-related acute lung injury (TRALI) 

Some side effects occur due to changes in the brand of immunoglobulin injection. Side effects may also occur due to the other ingredients in the injection formulation or because of the speed of administration.

Assessing the involved risk factors beforehand, infusing at a slow rate, premedicating, and switching from IVIG to subcutaneous immunoglobulin can minimize adverse effects. Adverse effects are rarely disabling or fatal. Treatment mainly involves supportive measures, and the majority of affected patients have a good prognosis. 

Overall, IVIG is considered a safe therapy when given at a slow infusion rate in well-hydrated patients.

Is Immunoglobulin Made From Humans?

Immunoglobulin is made from human blood. When blood is donated and spun to separate the blood components, the clear liquid fraction of blood is called plasma. Plasma contains antibodies that are separated for injection purposes.

Is IVIG the Same as Immunotherapy?

IVIG is considered a type of immunotherapy because it is used to treat many different autoimmune disorders, infections, or other conditions. It also helps prevent infections in patients who have had a stem cell or organ transplant. 

Cost of IVIG Treatment

The cost of IVIG treatment will depend upon the patient’s disease status, need, and frequency of medication. Hence, the cost will differ from person to person. On average, IVIG costs $200 to $350 per gram. However, this cost may vary according to different brands. The treatment cost for Guillain-Barre syndrome is about $20,000, and for other indications, the costs might exceed $30,000.

AmeriPharma® Specialty Care offers Infusion therapy in the comfort of your home, which can help reduce costs compared to receiving the infusion at the hospital or infusion center.

If you are interested in receiving IVIG therapy at home, consult with a specialist at AmeriPharma® to further discuss your options.

What If I Miss a Dose of Immune Globulin Injection?

If you are unable to keep an appointment, call your doctor or health care professional. If you give yourself the medicine and you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only the next dose. Do not take double or extra doses.

Do Immune Globulin Injections Cause Blood Clots?

Intravenous immunoglobulin may increase the risk of blood clots. Tell your doctor or a clinical staff at AmeriPharma® immediately if you experience pain, warmth, swelling, discoloration of any of your extremities, shortness of breath, chest pain, rapid heartbeat, numbness, or weakness on one side of the body.

Copay Assistance

Copay assistance is available to reduce your financial burden. AmeriPharma® offers assistance to help with any copays you may have. Using advanced software, AmeriPharma® will review all available funding sources and match you with a program that fits your needs. A copay specialist will then help you with the application process. 

For more information, speak to one of our specialists about how AmeriPharma® can help.

Important Points To Remember

• IVIG and SCIG are not interchangeable without medical supervision.
• Product selection should be individualized for each patient.
• Any changes in treatment should be guided by your healthcare provider.
• Switching products or routes should be done in a monitored setting.

Conclusion

Immune globulin therapy plays a critical role in the treatment of primary immunodeficiency and certain autoimmune conditions. By providing passive immunity, it helps reduce infections and improve the quality of life.

Treatment plans vary based on individual needs, and regular monitoring is essential to ensure effectiveness and safety. When used appropriately, immunoglobulin therapy is a well-established and highly beneficial treatment option.