IVIg Therapy for Autoimmune Disorders: How to Recognize, Manage, and Prevent Adverse Reactions
IVIg therapy can make a critical difference for patients with autoimmune disorders. Tammy Lightner, VP of Clinical Services, shares insights on how to manage side effects so therapy stays safe, comfortable, and effective.
Why Timely Diagnosis Matters in Autoimmune Disorders and IVIg Therapy
Scholars estimate 3 to 4.5 percent of people in the United States—roughly 10 to 15 million individuals—live with an autoimmune disorder. Chances are, you or someone you know is affected by one of these chronic conditions, which occur when the immune system mistakenly attacks the body’s own healthy tissues.
According to American Autoimmune Related Diseases Association, the average person living with an autoimmune condition will see about four doctors over a span of 4.5 years before receiving an accurate diagnosis. For those navigating this long and often difficult journey, it becomes especially important to make the most of treatment once it begins—understanding its efficacy, recognizing how it’s helping, and learning how to manage potential side effects. I write this blog not only as a healthcare professional who helps oversee patients with autoimmune diseases, but also as a patient living with one myself.
IVIg Therapy: A Key Treatment Option for Autoimmune Disorders
Treatment is highly dependent on both the type and severity of the autoimmune disorder you have. One treatment used across a range of autoimmune conditions is intravenous immunoglobulin therapy, commonly known as IVIg. This therapy has been successfully used to treat patients for more than 30 years; however, reports indicate up to 5 to 15 percent of all IVIg infusions result in undesirable side effects, impacting 20 to 30 percent of patients receiving the therapy.
Managing Side Effects So You Get the Most from IVIg
Fortunately, most adverse reactions to IVIg are mild and require minimal intervention. To help ensure the best possible outcomes with this therapy, I want to review the potential adverse reactions, suggested treatments, and preventive measures for some of the immediate, acute, and delayed reactions patients may encounter.
Conducting thorough assessments and understanding potential risk factors are essential for preventing, recognizing, and properly treating adverse reactions in patients receiving IVIg infusions. Risk factors include:
- Patients receiving IVIg for the first time
- Immunoglobulin-deficient patients with an active infection
- Patients receiving an IVIg product from a different manufacturer than previously used
- Patients who are not well hydrated
- Patients with a history of IVIg-related adverse reactions
Recognizing Immediate Adverse Reactions to IVIg Therapy
Immediate reactions are those that occur within the first 30 to 60 minutes of an IVIg infusion. The most common reactions include low-grade fever, headache, skin rash, and mild nausea.
Below are common treatments and preventive measures for managing these immediate adverse reactions. A physician’s order and the patient’s medical history should always be referenced prior to administration.
| Reaction | Action | Preventive Measures |
| Low-grade fever | – Acetaminophen – Ibuprofen – Comfort measures as applicable | – Pre-medicate 30 minutes prior to infusion – Infuse at a slower rate – Oral pre-hydration |
| Headache | – Acetaminophen – Solu-Medrol – IV hydration – Comfort measures as applicable | – Pre-medicate 30 minutes prior to infusion – Infuse at a slower rate – Oral pre-hydration |
| Skin rash/Urticaria | – Benadryl – Cortisone cream – Solu-Medrol – Comfort measures as applicable | – Pre-medicate 30 minutes prior to infusion – Infuse at a slower rate – Oral pre-hydration |
| Mild nausea | – Zofran – Comfort measures as applicable | – Pre-medicate 30 minutes prior to infusion – Infuse at a slower rate – Oral pre-hydration |
How To Identify and Treat Acute IVIg Adverse Reactions
Acute reactions are those that occur within the first 24 hours following an IVIg infusion. While less common than immediate adverse reactions, your prompt recognition and response are vital to achieving a positive outcome. The rate of infusion, along with the patient’s tolerability of the immunoglobulin (Ig) product composition, may contribute to many acute adverse reactions.
Below are common treatments and preventive measures for managing acute adverse reactions. A physician’s order and the patient’s medical history should always be referenced prior to administration.
| Reaction | Action | Preventive Measures |
| Anaphylaxis | – Stop infusion – Epinephrine – Do not restart infusion – Call 911 – Contact MD | – Pre-medicate 30 minutes prior to infusion – Switch to subcutaneous route – Change IVIg product – Obtain labs per PO |
| Acute Hemolysis | – Stop infusion – IV hydration – Do not restart infusion – Contact MD – Obtain first voided post-reaction urine – Obtain labs per PO – Comfort measures as applicable | – Switch to subcutaneous route – Change IVIg product – Infuse at a slower rate |
Delayed IVIg Adverse Reactions: What Patients and Caregivers Should Know
Delayed reactions are rare and occur more than 24 hours after an IVIg infusion. Because these reactions typically happen after the nurse has left the home, it is vital that patients and their caregivers know how to recognize and respond appropriately.
Delayed adverse reactions may include prolonged and severe headaches, aseptic meningitis, and acute renal failure. Patients should contact their physician immediately, as hospitalization may be required.
Below are common treatments and preventive measures for managing delayed adverse reactions. A physician’s order and the patient’s medical history should always be referenced prior to administration.
| Reaction | Action | Preventive Measures |
| Prolonged and severe headache | – Contact MD/911 – Benadryl – Solu-Medrol – IV hydration – Comfort measures as applicable | – Pre-medicate 30 minutes prior to infusion – IV hydration prior to infusion – Infuse at a slower rate |
| Aseptic meningitis | – Contact MD/911 – Benadryl – Solu-Medrol – Zofran – IV hydration – Comfort measures as applicable | – Pre/post medication – IV hydration prior to infusion – Infuse at a slower rate |
| Acute renal failure | – Contact MD/911 – Urine output measurements – Obtain labs per PO – Comfort measures as applicable | – Change IVIG product (usually seen with products containing sucrose) – IV hydration prior to infusion |
Key Takeaways for Supporting a Positive IVIg Therapy Experience
IVIg is an effective, safe, and well-tolerated therapy for many patients with autoimmune disorders. Careful risk assessment, infusing at slow rates, appropriate pre-medication, and proper hydration can significantly reduce the likelihood of adverse reactions.
While most adverse reactions are mild and easily managed, it is essential that all patients, caregivers, and healthcare professionals remain vigilant in recognizing signs of reaction. Prompt identification and intervention help ensure patient safety and prevent unnecessary disruptions to this life-sustaining therapy. Through proactive care and informed monitoring, most people can receive the full benefit of IVIg therapy.
Resources
- New study calculates autoimmune disease prevalence in U.S. – Mayo Clinic News Network
- Arumugham, Vijay B. and Rayi, Appaji. Intravenous Immunoglobulin (IVIG). StatPearls, August 19, 2021. Intravenous Immunoglobulin (IVIG) – StatPearls – NCBI Bookshelf (nih.gov)
- Immune Deficiency Foundation. IDF Patient & Family Handbook 6th edition, 2019. Immunoglobulin Replacement Therapy | Immune Deficiency Foundation (primaryimmune.org)
- Katz, Jessica. Medscape: What are common adverse effects from intravenous immunoglobulin (IVIG) and how are they prevented. Jul 05 2018. https://medscape.com/answers/210367-32907/what-are-common-adverse-effects-from-intravenous-immunoglobulin-ivig-and-how-are-they-prevented
- Calgary Laboratory Services. Intravenous Immune Globulin (IVIG) Reaction Chart. https://albertahealthservices.ca/assets/wf/lab/wf-lab-clin-tm-ivig-reactions
- Fernandez, James. Overview of Immunodeficiency Disorders. Apr 2021. Overview of Immunodeficiency Disorders – Immunology; Allergic Disorders – Merck Manuals Professional Edition
- National Institute of Allergy and Infectious Diseases. OMB#0925-0668, June 21, 2016. Primary Immune Deficiency Diseases (PIDDs) | NIH: National Institute of Allergy and Infectious Diseases
