2012 Nov 22 – Intravenous Immune Globulin in Autoimmune and Inflammatory Diseases

Erwin W. Gelfand, M.D. N Engl J Med 2012; 367:2015-2025November 22, 2012
In an era in which new biologics are being introduced to target inflammation and autoimmunity, some older treatments persist. Immune globulin–replacement therapy has been a lifesaving treatment for patients with antibody deficiency. When immune globulin replacement was introduced in the 1950s for the treatment of primary immunodeficiency diseases, it was administered subcutaneously or by intramuscular injection; subsequently, preparations suitable for intravenous use were developed, and these have undergone progressive changes in composition, particularly the elimination of sugars and normalization of the salt content and osmolarity.

As a result, reactions have become much less frequent. Intravenous immune globulin is prepared from plasma pooled from thousands of healthy donors. This pooling provides a diversity of antibody repertoires and antibody specificities. More than a dozen preparations suitable for intravenous administration have been approved by the Food and Drug Administration (FDA) for the treatment of primary immunodeficiency diseases.
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