What Is Intravenous Immunoglobulin? How Does It Work in Children With Low Immunity? by Dr. Sagar Bhattad

10 min read

Written by Dr. Sagar Bhattad

Dr. Sagar Bhattad

Dr Sagar Bhattad is a renowned Pediatric Immunologist and Rheumatologist in Bengaluru. He is the first DM in India in Pediatric Clinical Immunology and Rheumatology specialty.

He received hi More

Intravenous Immunoglobulin

The human body is a complex machine that keeps working day and night. The immune system is what protects it from all harm. We are all familiar with “falling sick”, “catching a cold” and even diseases that require serious treatments.

What happens when this shield called the immune system has a defect right from the start? What if this “defect” interferes with the way the body is protected? Or what are the diseases that can attack? What can you do when this immune system attacks the body instead of protecting it? This is where immunoglobulin is given intravenously to compensate for the lack of antibodies produced in the body. This is not a so uncommon treatment given to treat various immunity disorders. But, what about children? Can this be given to children?

In This Article

What is Intravenous Immunoglobulin?

Immunoglobulin is a component that the human body naturally produces to fight infections. It helps the immune system effectively protect the body against foreign invaders. However, some people do not produce enough or any of it. This leads to an immunity disorder that requires external intervention, to help the body in its fight against infections. Immunoglobulin injections treat a number of immune deficiency disorders. This helps increase the immunoglobulin levels in the blood of the patient and protects them from infections.

Intravenous Immunoglobulin (IVIg) injections are also used to treat inflammatory issues, better known as autoimmune diseases.

immunoglobulins

The blood of healthy individuals is used to make IVIg. The antibody proteins are extracted from the plasma. The plasma from 1000 to 15000 donors, per batch of IVIg, approximately. The donors undergo testing to ensure no disease transfers through the blood plasma. The IVIg product undergoes to ensure it contains no diseases. The solution undergoes certain procedures to destroy any viruses present in them.

It has a good success rate treating ailments like

  • ITP – a disease wherein patients have low platelets.
  • Kawasaki disease
  • Guillain-Barre-Syndrome
  • Graves Ophthalmopathy
  • Polyneuropathies

Medical professionals are also increasingly using IVIg to treat certain common diseases where other treatments are ineffective.

Is Intravenous Immunoglobulin Commonly Used?

Intravenous Immunoglobulin infustion

IVIg is quite common and one of the most effective treatments for autoimmune diseases. It helps the body fight from within rather than treat the illness with various medications. However, it is not readily available in all countries. We are fortunate in India to have many companies marketing this important product.

Though doctors and hospitals in India do administer IVIg, it can be an expensive affair for many. Most companies import this medication from India and for this reason, administering the treatment is expensive. This has been a major reason for the low awareness and usage of IVIg in India, among the non-affluent people. Of late, a few companies have established IVIg production plants within the country and this should help reduce the cost of this medication.

Can IVIg be Given to Children?

Yes, it can be. Doctors prescribe it to children suffering from severe immunity disorders. Primary Immunodeficiency Diseases consist of over 450 disorders. IVIg helps treat these disorders. It provides a variety of antibodies and the doctors adjust the dose according to the child’s requirement.

Intravenous Immunoglobulin helps to fight the infection and impacts the production of antibodies in the body. This has a long-term positive impact on the patient. However, the child must meet certain conditions to qualify for this treatment.

Some of the departments that use this product in high dosage are:

  1. Neurology
  2. Hematology
  3. Nephrology
  4. Immunology
  5. Dermatology
  6. Rheumatology

You can find the list of disorders treated with IVIg here.

Your child may need IVIg in the following scenarios:

1. Immune Replacement Therapy

Some children may not make sufficient antibodies right from the time of birth. Some may not make enough due to the effect of some treatments like chemotherapy. This could be the reason for infections being present from birth or for infections they contract. IVIg can be given to such children. This helps prevent serious infections in the future.

2. Immunomodulation Therapy

When the immune system attacks the body instead of protecting it, IVIg treatment helps the immune system function better. This is the reason why IVIg is very useful in the treatment of autoimmune diseases.

  • For eg: IVIg can treat autoimmune neurological problems (Guillain-Barre-Syndrome), autoimmune muscle weakness (dermatomyositis), and many such diseases. This medicine works quickly and patients who respond, tend to recover well.
  • Kawasaki disease commonly affects young children (below 5 yrs of age). It causes the blood vessels of the heart (coronaries) to swell up and this can have serious consequences. IVIg is very useful in the treatment of this disease.

3. Prevention of Infection Following Exposure

Following a dog bite, there is a risk of contracting rabies, a dangerous disease. You can treat this by providing rabies immunoglobulin injection along with rabies vaccine.

Will IVIg Hurt My Child?

nurse giving IVIg for child with mother

Every parent is concerned about how it will hurt their child.

Though the infusion itself may not hurt for most children, inserting the IV catheter can be painful. This depends on the medical professional and the placement of the catheter. Some hospitals may use numbing sprays or creams to ease the pain of pricking.

The age-old distraction technique can help too. It can be quite difficult to get a child to cooperate when a nurse comes in with a needle. The parent has to find ways to get the IV line in without much of a fuss, as wrong placements or a shake while inserting the line can result in repeating the procedure from start.

How is Intravenous Immunoglobulin Given to Children?

child taking IV drips

The doctor or medical expert will give IVIg directly through the child’s vein through an IV drip. It is given very slowly to avoid any reactions to the plasma. Some people react to foreign blood or plasma entering the body.

The product undergoes testing before giving the full dosage. Only if there are no negative reactions, will the doctor continue with this line of treatment.

  • The IVIg is given as a replacement dose of approximately 400-600 mg per kg of body weight. This is given about once every 3-4 weeks.
  • In case of severe immunity disorders or inflammatory disorders, the doctor will prescribe a high dose of 2g per kg of body weight every month. Here, this product acts as an immunomodulatory agent.

The preparation of this medication can differ from brand to brand. Your doctor should be able to guide you to find the right choice for your child. Generally, the doctor will suggest the same brand for every infusion. The doctors don’t change brands once they have found the right match.

The IVIg infusion is given slowly. This ensures there is no severe reaction to the solution. The doctor will give the infusion at a slow pace in the first hour. If there are no reactions, they will increase the pace. It will take about three hours for one bottle to go in. The time can vary from patient to patient, depending on how the body tolerates the infusion. Some children may require a further slow pace infusion to help the body cope.

The frequency of these IVIg infusions will depend on the illness, the age of the child, the doctor’s analysis, etc. Do check with your doctor regarding this.

How Long Does IVIg Take to Work?

For inflammatory diseases requiring a high dose IVIg (2g/kg), the medication starts working within a few days. In cases of immune deficiencies, IVIg treatment (400 mg/kg) should start working within a few weeks. However, this can vary from individual to individual. It depends on

  1. The illness
  2. The way the child’s body reacts to IVIg
  3. Quantity of IVIg given
  4. Other additional treatments

Each individual will have a different reaction to different treatments. If your child is not responding well to this treatment, the doctor might suggest waiting a little longer or changing the course of treatment. There are different IVIg brands available too. The antibodies present in them should be specific to the disease they have to fight. Doctors might try different IVIg too.

If this doesn’t work at all, alternate treatment options will be explored.

Once the IVIg starts working for your child, the effect will last for a few weeks. For some children, the effect of the treatment can start deteriorating sooner than expected. In such cases, more transfusions may be required. It can also indicate that while IVIg is able to strengthen the body, it is unable to effectively fight the infection on a long-term basis.

Risks and Side Effects of IVIg on Children

child having Breathing Difficulty

Each body reacts differently to various medicines and treatments. The IVIg usually does not have any serious side effects. However, if the child is sensitive or if the plasma does not suit the child, there could be some side effects.

If your child has experienced any side effects of certain medicines in the past, it is necessary to let your doctor know about it before the treatment starts.

Some of the common side-effects to expect are:

  1. Headaches
  2. Feeling cold
  3. Mild itching with the introduction of blood into the system
  4. Muscle aches
  5. Tiredness/ fatigue
  6. Stomach aches
  7. Back pain

Some of the more serious but rare side-effects that may occur are:

  1. Wheezing/ difficulty breathing
  2. Swelling of the throat/ tongue
  3. Tightening of the chest
  4. Rashes on the skin
  5. Dizziness/ lightheadedness
  6. A drop in blood pressure
  7. Disturbance in vision
  8. Severe or very painful headache
  9. Blood clots

It is very important to keep a close watch on your child when they receive a transfusion. If you notice any side effects, or if your child starts complaining of any discomfort, reach out to the nearest medical care professional immediately. Keeping your doctor informed is also crucial. If a type of IVIg does not suit your child, the doctor might consider an alternative.

The nurses will also keep a close watch on the child throughout the transfusion. Your child’s temperature, blood pressure, heart rate, breathing rate, etc., will undergo regular checking and monitoring to ensure the transfusion does not impact these parameters.

Sometimes the side-effects may not be instant. They can take up to 24 hours to show up. This is why it is crucial for parents to keep a close watch on their children. Never ignore or take lightly any symptoms. Keep your doctor informed and let them take a call.

[Read : Importance of Influenza Vaccine for Children Pre-Monsoon During COVID Times]

Will IVIg Interfere With Other Treatments?

doctor with sick child

Usually, IVIg does not interfere with other drugs or treatments. However, you must inform your child’s doctor about the IVIg treatment. If you are taking your child to a new or a different doctor, always mention the IVIg treatment, so that they can decide the course of treatment accordingly.

IVIg can react with vaccinations. So, it is important to discuss the vaccines before you start the treatment for your child. Some live vaccines (MMR, Varicella) are avoided for a few months if a high dose IVIg has been given. Children with immune deficiencies who take monthly IVIg infusions should avoid all live vaccines. Killed influenza vaccine must be given once a year to these patients.

Taking the vaccines along with the IVIg treatment might reduce their effectiveness or cause reactions in the child. This is a complication that can be and has to be avoided. The best course of action will be to discuss it with your doctor. They will know which are live vaccines and which are not, and will guide you accordingly.

If you have given any vaccines for your child before you start the IVIg treatment, ensure you clearly mention it to the doctor when they start discussing treatment options.

Similarly, if your child is slated for any surgery – planned or unplanned, ensure you let the surgeon know about the IVIg treatment. They will alter the dosage of medicines used, accordingly.

[Read : Chickenpox and its Vaccine for Babies]

Alternatives to Intravenous Immunoglobulin

Subcutaneous immunoglobulin injection

Is IVIg the only solution? Are there any alternative treatments available?

Intravenous Immunoglobulin is not feasible for all. It is expensive and also takes time. The patient will have to undergo the treatment for many months or even years. Also, not all hospitals can provide this treatment.

In such a case, alternative treatments will be suggested based on the disease to be treated. Some of the alternate immunosuppressants that may be used to treat autoimmune diseases are:

  • Azathioprine
  • Methotrexate
  • Rituximab

Some of these are more cost-effective and convenient too.

In some cases, the immunoglobulin is not given intravenously. It is administered subcutaneously (SCIG).

Some of the advantages of this treatment are:

  1. It does not require your child to be hospitalized. Thus bringing down both the costs as well as the trauma.
  2. If the child does not have good venous access, IVIg can be very painful and complicated. The SCIG is safer and easier.
  3. SCIG has a better tolerance rate to immunoglobulin when compared to IVIg.
  4. Dosage can change based on the requirement. The flexibility makes administering this medicine easier.
  5. The side effects are much lesser in SCIG than IVIg.
  6. It is easy to administer without the help of a medical professional. The parents can learn to administer it and do it themselves as recommended in the comfort of their homes.
  7. Quality of life can be better when the medications are administered at home and do not require the child and the family to stay in a hospital.

Difficulty in Finding an Alternate

IVIg’s biggest challenge lies in the sourcing process. Since it has to be derived from donors, the supply is highly limited. The safety precautions are also high, especially when there are new diseases and outbreaks that require special checks. This in turn drives up the costs.

To add to this, many illnesses require high doses rather than replacement doses. Thus increasing the demand too. This has created an urgent need to find alternate solutions and treatment options for diseases that heavily depend on IVIg as a cure.

Substitutes

Clinical trials are being conducted along with increasing research to find alternatives to IVIg. Synthetically producing a replacement has its own challenges and requires a lot of testing too. Since IVIg is a tried and tested treatment for many autoimmune diseases, replacing it with synthetic substitutes or other medicines has its own set of challenges. The biggest challenge is the inability of the immune system to fight any harmful components in the substitutes.

IVIg is an effective treatment that has been tried and tested for many years. This can be a good treatment option for children with immune deficiencies and autoimmune diseases. Discuss various available options with your doctor and choose the right path that will suit both your child and your budget. Though this is an effective medication for low immunity, it has its own side effects to consider too.

Read Also: Biologics For Autoimmune Diseases – A New Treatment For Children by Dr. Sagar Bhattad

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Dr. Sagar Bhattad, MBBS, MD Pediatrics
DM - Pediatric Clinical Immunology and Rheumatology, Aster CMI Hospital
7 years of experience

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