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IgA and IgG Subclass Deficiencies Follow-up

  • Author: Terry W Chin, MD, PhD; Chief Editor: Harumi Jyonouchi, MD  more...
 
Updated: Aug 15, 2014
 

Further Outpatient Care

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  • Because immunoglobulin (Ig)G subclass and/or isolated IgA deficiency are observed most commonly in atopic or autoimmune disorders, treating the concomitant diseases is crucial. Adequate treatment for the underlying allergic component may substantially decrease the rate of chronic upper and lower respiratory infections.
  • Live viral vaccines are not a risk in partial defects. When the diagnosis of partial defects is established, live viral vaccines can be administered. However, the risk occurs when the exact diagnosis is not known. Until concomitant T-cell deficiency is ruled out, live viral vaccines should be avoided in the patient and in siblings or other children in the house because the attenuated virus is excreted and poses a threat to the severely immunodeficient patient.
  • Sorensen et al (1998) showed that a significant percentage of children with specific antibody deficiency develop protective antibody levels to the conjugated pneumococcal vaccine (Prevnar) with subsequent decreased infections.[60]
  • In addition, serum IgA subclass levels, IgG subclass levels, or both may increase to normal range in more than 50%.[50] Therefore, regular monitoring of immunoglobulin levels should be done. Conversely, levels may decrease and lose specific immunoglobulin production as some patients progress to common variable immunodeficiency (CVID).
  • Do not make a decision to start IVIg treatment lightly. Although its beneficial effect for patients with agammaglobulinemia or hypogammaglobulinemia is not controversial, its use in IgG subclass deficiency or specific antibody deficiency in the presence of normal total Igs is not routine. In 1999, Lawton pointed out that patients, their parents, or the referring physician often insist on a trial of Ig therapy.[61] When this results in a beneficial effect, discontinuation is often difficult because "the child's health and family peace soon become dependent on continuation of the treatment."[61]
  • In addition to the high cost of IVIg and the emotional stress of monthly infusions, keep in mind the real possibility of IVIg transmitting unknown infectious agents. Hepatitis C virus transmission has been documented with certain IVIg preparations.
  • Families usually agree to a predetermined interval for an empiric trial of IVIg if the clinical problems with recurrent upper and lower respiratory infections appear to be sufficiently severe in patients younger than 4 years. This may occur during the winter, ending in spring. Immunologic testing then can be repeated 3-4 months after the last infusion. Restart treatment only if the antibody response remains abnormal.
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Complications

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  • Prevent chronic upper and lower respiratory disorders by treating underlying allergic disorders (eg, rhinitis, asthma) with aggressive use of antibiotics to manage bacterial infections (eg, sinusitis, bronchitis, pneumonias). Chronic ear infections can cause hearing loss. Watch for mastoiditis.
  • In one study, chronic pulmonary damage, as determined on chest CT scanning, occurred in about 20% of patients.[49] In the converse, extensive evaluation of patients with bronchiectasis showed that 11% had polysaccharide antibody deficiency to either pneumococcal or HIB vaccines.[29]
  • No good studies have been conducted to examine the potential benefits of prophylactic antibiotics, given systemically or topically (ie, aerosolized), in patients with B-cell disorder. However, it can be invaluable in selected patients.
  • Patients with impaired responses to vaccines may eventually develop CVID, possibly with concomitant T-cell deficiency. Closely follow up such patients and serially assess specific antibody responses (protein and polysaccharide antigens) and IgG subclasses and/or IgA serum levels.
  • Some IgA deficiency also occurs in patients with T lymphocyte deficiency such as ataxia-telangiectasia. Live viral vaccines should be avoided in these patients.
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Prognosis

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  • The prognosis of patients with these B-cell disorders depends on the severity of the humoral deficiency and on the extent to which other associated disorders, such as atopic or autoimmune diseases, are involved.
  • IVIg therapy offers a good prognosis for patients with the most severe form of antibody deficiency (ie, agammaglobulinemia).
  • In many individuals, selective IgA deficiency occurs without respiratory or intestinal symptoms. The role of selective IgG deficiency role in susceptibility to infections is similarly uncertain because many individuals with selective IgG deficiency are asymptomatic.
  • Most patients with IgA and IgG subclass deficiency who are younger than 4 years do well with appropriate antibiotic therapy and outgrow their frequent or recurrent infections, especially if they can make specific antibodies. Closely monitor patients who have IgG subclass deficiency that does not improve to assess for relatively complete B-cell deficiency such as CVID.[10]
  • Wolpert and Knutsen reported on 120 children with specific antibody deficiency and found that 50% developed normal responses after a mean of 3.1 years.[62] IVIg was administered in 28% of these children. Similar findings were reported by Kutukculer et al.[50]
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Patient Education

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  • Because of the close association with various allergic and autoimmune disorders, parents and patients must be aware of any underlying chronic atopic disorders.
  • Possible allergic triggers may require additional intervention with allergy testing and medical treatment.
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Contributor Information and Disclosures
Author

Terry W Chin, MD, PhD Associate Clinical Professor, Department of Pediatrics, University of California, Irvine, School of Medicine; Associate Director, Cystic Fibrosis Center, Attending Staff Physician, Department of Pediatric Pulmonology, Allergy, and Immunology, Memorial Miller Children's Hospital

Terry W Chin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American College of Chest Physicians, American Federation for Clinical Research, American Thoracic Society, California Society of Allergy, Asthma and Immunology, California Thoracic Society, Clinical Immunology Society, Los Angeles Pediatric Society, Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD Faculty, Division of Allergy/Immunology and Infectious Diseases, Department of Pediatrics, Saint Peter's University Hospital

Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Pediatric Research, Society for Mucosal Immunology

Disclosure: Nothing to disclose.

Acknowledgements

John Wilson Georgitis, MD Consulting Staff, Lafayette Allergy Services

John Wilson Georgitis, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association for the Advancement of Science, American College of Chest Physicians, American Lung Association, American Medical Writers Association, and American Thoracic Society

Disclosure: Nothing to disclose.

References
  1. Gathmann B, Binder N, Ehl S, Kindle G. The European internet-based patient and research database for primary immunodeficiencies: update 2011. Clin Exp Immunol. 2012 Mar. 167(3):479-91. [Medline]. [Full Text].

  2. Plebani A, Ugazio AG, Meini A, et al. Extensive deletion of immunoglobulin heavy chain constant region genes in the absence of recurrent infections: when is IgG subclass deficiency clinically relevant?. Clin Immunol Immunopathol. 1993 Jul. 68(1):46-50. [Medline].

  3. Blutt SE, Miller AD, Salmon SL, Metzger DW, Conner ME. IgA is important for clearance and critical for protection from rotavirus infection. Mucosal Immunol. 2012 Jun 27. [Medline].

  4. Santaella ML, Peredo R, Disdier OM. IgA deficiency: clinical correlates with IgG subclass and mannan-binding lectin deficiencies. P R Health Sci J. 2005 Jun. 24(2):107-10. [Medline].

  5. Anantaphruti MT, Nuamtanong S, Dekumyoy P. Diagnostic values of IgG4 in human gnathostomiasis. Trop Med Int Health. 2005 Oct. 10(10):1013-21. [Medline].

  6. Constantin C, Huber WD, Granditsch G, et al. Different profiles of wheat antigens are recognised by patients suffering from coeliac disease and IgE-mediated food allergy. Int Arch Allergy Immunol. 2005 Nov. 138(3):257-66. [Medline].

  7. Palmer DS, O'Toole J, Montreuil T, et al. Screening of Canadian Blood Services donors for severe immunoglobulin A deficiency. Transfusion. 2010 Jul. 50(7):1524-31. [Medline].

  8. Weber-Mzell D, Kotanko P, Hauer AC, et al. Gender, age and seasonal effects on IgA deficiency: a study of 7293 Caucasians. Eur J Clin Invest. 2004 Mar. 34(3):224-8. [Medline].

  9. Aghamohammadi A, Cheraghi T, Gharagozlou M, et al. IgA deficiency: correlation between clinical and immunological phenotypes. J Clin Immunol. 2009 Jan. 29(1):130-6. [Medline].

  10. Aghamohammadi A, Mohammadi J, Parvaneh N, et al. Progression of selective IgA deficiency to common variable immunodeficiency. Int Arch Allergy Immunol. 2008. 147(2):87-92. [Medline].

  11. Priyadarsi A, Sankar J. H1N1 infection associated with persistent lower respiratory tract illness in an infant with isolated IgA deficiency. BMJ Case Rep. 2012 Feb 21. 2012:[Medline].

  12. Aytekin C, Tuygun N, Gokce S, Dogu F, Ikinciogullari A. Selective IgA Deficiency: Clinical and Laboratory Features of 118 Children in Turkey. J Clin Immunol. 2012 May 1. [Medline].

  13. Shkalim V, Monselize Y, Segal N, Zan-Bar I, Hoffer V, Garty BZ. Selective IgA deficiency in children in Israel. J Clin Immunol. 2010 Sep. 30(5):761-5. [Medline].

  14. Franco A, Parrella R, Murru F, et al. Lack of association between IgA deficiency and respiratory atopy in young male adults. In Vivo. 2011 Sep-Oct. 25(5):829-32. [Medline].

  15. Siriaksorn S, Suchaitanawanit S, Trakultivakorn M. Allergic rhinitis and immunoglobulin deficiency in preschool children with frequent upper respiratory illness. Asian Pac J Allergy Immunol. 2011 Mar. 29(1):73-7. [Medline].

  16. Janzi M, Kull I, Sjoberg R, et al. Selective IgA deficiency in early life: association to infections and allergic diseases during childhood. Clin Immunol. 2009 Oct. 133(1):78-85. [Medline].

  17. Gold PW, Pavlatou MG, Carlson PJ, et al. Unmedicated, remitted patients with major depression have decreased serum immunoglobulin A. Neurosci Lett. 2012 Jun 27. 520(1):1-5. [Medline].

  18. Feng ML, Zhao YL, Shen T, et al. Prevalence of immunoglobulin A deficiency in Chinese blood donors and evaluation of anaphylactic transfusion reaction risk. Transfus Med. 2011 Oct. 21(5):338-43. [Medline].

  19. Basturk B, Sari S, Aral A, Dalgic B. Prevalence of selective immunoglobulin A deficiency in healthy Turkish school children. Turk J Pediatr. 2011 Jul-Aug. 53(4):364-8. [Medline].

  20. Yel L. Selective IgA deficiency. J Clin Immunol. 2010 Jan. 30(1):10-6. [Medline]. [Full Text].

  21. Ramanujam R, Piehl F, Pirskanen R, Gregersen PK, Hammarstrom L. Concomitant autoimmunity in myasthenia gravis--lack of association with IgA deficiency. J Neuroimmunol. 2011 Jul. 236(1-2):118-22. [Medline]. [Full Text].

  22. Jorgensen GH, Ornolfsson AE, Johannesson A, et al. Association of immunoglobulin A deficiency and elevated thyrotropin-receptor autoantibodies in two Nordic countries. Hum Immunol. 2011 Feb. 72(2):166-72. [Medline].

  23. Chow MA, Lebwohl B, Reilly NR, Green PH. Immunoglobulin A Deficiency in Celiac Disease. J Clin Gastroenterol. 2012 Apr 2. [Medline].

  24. Carr TF, Koterba AP, Chandra R, et al. Characterization of specific antibody deficiency in adults with medically refractory chronic rhinosinusitis. Am J Rhinol Allergy. 2011 Jul-Aug. 25(4):241-4. [Medline]. [Full Text].

  25. Tuerlinckx D, Vermeulen F, Pekus V, et al. Optimal assessment of the ability of children with recurrent respiratory tract infections to produce anti-polysaccharide antibodies. Clin Exp Immunol. 2007 Aug. 149(2):295-302. [Medline]. [Full Text].

  26. Boyle RJ, Le C, Balloch A, Tang ML. The clinical syndrome of specific antibody deficiency in children. Clin Exp Immunol. 2006 Dec. 146(3):486-92. [Medline]. [Full Text].

  27. van Kessel DA, van Velzen-Blad H, van den Bosch JM, Rijkers GT. Impaired pneumococcal antibody response in bronchiectasis of unknown aetiology. Eur Respir J. 2005 Mar. 25(3):482-9. [Medline].

  28. Vendrell M, de Gracia J, Rodrigo MJ, et al. Antibody production deficiency with normal IgG levels in bronchiectasis of unknown etiology. Chest. 2005 Jan. 127(1):197-204. [Medline].

  29. Wiertsema SP, Veenhoven RH, Sanders EA, Rijkers GT. Immunologic screening of children with recurrent otitis media. Curr Allergy Asthma Rep. 2005 Jul. 5(4):302-7. [Medline].

  30. Cheng YK, Decker PA, O'Byrne MM, Weiler CR. Clinical and laboratory characteristics of 75 patients with specific polysaccharide antibody deficiency syndrome. Ann Allergy Asthma Immunol. 2006 Sep. 97(3):306-11. [Medline].

  31. Costa Carvalho BT, Nagao AT, Arslanian C, et al. Immunological evaluation of allergic respiratory children with recurrent sinusitis. Pediatr Allergy Immunol. 2005 Sep. 16(6):534-8. [Medline].

  32. Mrabet-Dahbi S, Breuer K, Klotz M, et al. Deficiency in immunoglobulin G2 antibodies against staphylococcal enterotoxin C1 defines a subgroup of patients with atopic dermatitis. Clin Exp Allergy. 2005 Mar. 35(3):274-81. [Medline].

  33. Gregorek H, Dzierzanowska-Fangrat K, Woynarowski M, Jozwiak P, Witkowska-Vogtt E, Socha J, et al. Persistence of HBV-DNA in children with chronic hepatitis B who seroconverted to anti-HBs antibodies after interferon-alpha therapy: correlation with specific IgG subclass responses to HBsAg. J Hepatol. 2005 Apr. 42(4):486-90. [Medline].

  34. de Laat PC, Weemaes CM, Bakkeren JA, et al. Familial selective IgA deficiency with circulating anti-IgA antibodies: a distinct group of patients?. Clin Immunol Immunopathol. 1991 Jan. 58(1):92-101. [Medline].

  35. Swedo SE, Leckman JF, Rose NR. (2012) From research subgroup to clinical syndrome: modifying the PANDAS criteria to describe PANS (pediatric acute-onset neuropsychiatric syndrome. Pediatr Therapeut. 2012. 2:2.

  36. Murphy TK, Storch EA, Lewin AB et al. (2012). Clinical factors associated with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. J Pediatr. 2012. 160:314-9.

  37. Schaffer FM. Clinical assessment and management of abnormal IgA levels. Ann Allergy Asthma Immunol. 2008 Mar. 100(3):280-2. [Medline].

  38. Browning MJ. Specific polysaccharide antibody deficiency in chromosome 18p deletion syndrome and immunoglobulin A deficiency. J Investig Allergol Clin Immunol. 2010. 20(3):263-6. [Medline].

  39. Toptygina AP, Pukhalsky AL, Alioshkin VA. Immunoglobulin G subclass profile of antimeasles response in vaccinated children and in adults with measles history. Clin Diagn Lab Immunol. 2005 Jul. 12(7):845-7. [Medline]. [Full Text].

  40. Tanaka M, Seki G, Ishizawa K, wet al. Resolution of Henoch-Schönlein purpura nephritis after acquired IgA deficiency. Pediatr Nephrol. 2010 Nov. 25(11):2355-8. [Medline].

  41. Paris K, Sorensen RU. Assessment and clinical interpretation of polysaccharide antibody responses. Ann Allergy Asthma Immunol. 2007 Nov. 99(5):462-4. [Medline].

  42. Freeman JA, Crassini KR, Best OG, et al. Immunoglobulin G (IgG) subclass deficiency and infection risk in 150 patients with chronic lymphocytic leukaemia. Leuk Lymphoma. 2012 Jun 27. [Medline].

  43. Shakkottai A, Bupathi K, Patel AP, et al. Children with partial IgA deficiency: clinical characteristics observed in the pediatric rheumatology clinic. Clin Pediatr (Phila). 2012 Jan. 51(1):46-50. [Medline].

  44. Fusaro AE, Fahl K, Cardoso EC, et al. Profile of autoantibodies against phosphorylcholine and cross-reactivity to oxidation-specific neoantigens in selective IgA deficiency with or without autoimmune diseases. J Clin Immunol. 2010 Nov. 30(6):872-80. [Medline].

  45. Rezaei N, Aghamohammadi A, Siadat SD, et al. Serum bactericidal antibody response to serogroup C polysaccharide meningococcal vaccination in children with primary antibody deficiencies. Vaccine. 2007 Jul 20. 25(29):5308-14. [Medline].

  46. Kamchaisatian W, Wanwatsuntikul W, Sleasman JW, Tangsinmankong N. Validation of current joint American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma and Immunology guidelines for antibody response to the 23-valent pneumococcal vaccine using a population of HIV-infected children. J Allergy Clin Immunol. 2006 Dec. 118(6):1336-41. [Medline].

  47. Garside JP, Kerrin DP, Brownlee KG, Gooi HC, Taylor JM, Conway SP. Immunoglobulin and IgG subclass levels in a regional pediatric cystic fibrosis clinic. Pediatr Pulmonol. 2005 Feb. 39(2):135-40. [Medline].

  48. Ozkan H, Atlihan F, Genel F, Targan S, Gunvar T. IgA and/or IgG subclass deficiency in children with recurrent respiratory infections and its relationship with chronic pulmonary damage. J Investig Allergol Clin Immunol. 2005. 15(1):69-74. [Medline].

  49. Kutukculer N, Karaca NE, Demircioglu O, Aksu G. Increases in serum immunoglobulins to age-related normal levels in children with IgA and/or IgG subclass deficiency. Pediatr Allergy Immunol. 2007 Mar. 18(2):167-73. [Medline].

  50. Cohn JA, Skorpinski E, Cohn JR. Prevention of pneumococcal infection in a patient with normal immunoglobulin levels but impaired polysaccharide antibody production. Ann Allergy Asthma Immunol. 2006 Nov. 97(5):603-5. [Medline].

  51. Sorensen RU, Leiva LE, Giangrosso PA, et al. Response to a heptavalent conjugate Streptococcus pneumoniae vaccine in children with recurrent infections who are unresponsive to the polysaccharide vaccine. Pediatr Infect Dis J. 1998 Aug. 17(8):685-91. [Medline].

  52. Meyts I, Bossuyt X, Proesmans M, De B. Isolated IgG3 deficiency in children: to treat or not to treat? Case presentation and review of the literature. Pediatr Allergy Immunol. 2006 Nov. 17(7):544-50. [Medline].

  53. Garcia-Lloret M, McGhee S, Chatila TA. Immunoglobulin replacement therapy in children. Immunol Allergy Clin North Am. 2008 Nov. 28(4):833-49, ix. [Medline]. [Full Text].

  54. Karaca NE, Gulez N, Aksu G, Azarsiz E, Kutukculer N. Does OM-85 BV prophylaxis trigger autoimmunity in IgA deficient children?. Int Immunopharmacol. 2011 Nov. 11(11):1747-51. [Medline].

  55. Borte S, Pan-Hammarstrom Q, Liu C, et al. Interleukin-21 restores immunoglobulin production ex vivo in patients with common variable immunodeficiency and selective IgA deficiency. Blood. 2009 Nov 5. 114(19):4089-98. [Medline].

  56. Hooper JA. Intravenous immunoglobulins: evolution of commercial IVIG preparations. Immunol Allergy Clin North Am. 2008 Nov. 28(4):765-78, viii. [Medline].

  57. Siegel J. The product: All intravenous immunoglobulins are not equivalent. Pharmacotherapy. 2005 Nov. 25(11 Pt 2):78S-84S. [Medline].

  58. Shah S. Pharmacy considerations for the use of IGIV therapy. Am J Health Syst Pharm. 2005 Aug 15. 62(16 Suppl 3):S5-11. [Medline].

  59. Sorensen RU, Leiva LE, Javier FC 3rd, et al. Influence of age on the response to Streptococcus pneumoniae vaccine in patients with recurrent infections and normal immunoglobulin concentrations. J Allergy Clin Immunol. 1998 Aug. 102(2):215-21. [Medline].

  60. Lawton AR. IgG subclass deficiency and the day-care generation. Pediatr Infect Dis J. 1999 May. 18(5):462-6. [Medline].

  61. Wolpert J, Knutsen AP. Natural history of selective antibody deficiency to bacterial polysaccharide antigens in children. Pediatr Asthma Allergy Immunol. 1998. 12:183-91.

  62. Papadopoulou A, Mermiri D, Taousani S, Triga M, Nicolaidou P, Priftis KN. Bronchial hyper-responsiveness in selective IgA deficiency. Pediatr Allergy Immunol. 2005 Sep. 16(6):495-500. [Medline].

  63. Abrahamian F, Agrawal S, Gupta S. Immunological and clinical profile of adult patients with selective immunoglobulin subclass deficiency: response to intravenous immunoglobulin therapy. Clin Exp Immunol. Mar 2010. 159:344-50. [Medline].

  64. Cunningham-Rundles C, Brandeis WE, Pudifin DJ, Day NK, Good RA. Autoimmunity in selective IgA deficiency: relationship to anti-bovine protein antibodies, circulating immune complexes and clinical disease. Clin Exp Immunol. 1981 Aug. 45(2):299-304. [Medline]. [Full Text].

  65. Jeurissen A, Moens L, Raes M, et al. Laboratory diagnosis of specific antibody deficiency to pneumococcal capsular polysaccharide antigens. Clin Chem. 2007 Mar. 53(3):505-10. [Medline].

  66. Lim MT, Jeyarajah K, Jones P, Pandya H, Doffinger R, Kumararatne D, et al. Specific antibody deficiency in children with chronic wet cough. Arch Dis Child. May 2012. 97:478-80. [Medline].

  67. Rawat A, Suri D, Gupta A, Saikia B, Minz RW, Singh S. Isolated Immunoglobulin G4 Subclass Deficiency in a Child with Bronchiectasis. Indian J Pediatr. Oct 2013. Epub:[Medline].

  68. Ruuskanen O, Nurkka A, Helminen M, Viljanen MK, Käyhty H, Kainulainen L. Specific antibody deficiency in children with recurrent respiratory infections: a controlled study with follow-up. Clin Exp Immunol. May 2013. 172:238-44. [Medline].

  69. Wang N, Shen N, Vyse TJ, et al. Selective IgA deficiency in autoimmune diseases. Mol Med. 2011. 17(11-12):1383-96. [Medline]. [Full Text].

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Table. Immune Globulin, Intravenous[56, 57, 58, 59]
Brand(Manufacturer)Manufacturing ProcesspHAdditives (IVIg products containing sucrose are most often associated with renal dysfunction, acute renal failure, and osmotic nephrosis, particularly with preexisting risk factors [eg, history of renal insufficiency, diabetes mellitus, age >65 y, dehydration, sepsis, paraproteinemia, nephrotoxic drugs]) Parenteral Form and Final ConcentrationsIgA Content mcg/mL
Carimune NF



(CSL Behring)



Kistler-Nitschmann fractionation; pH 4, nanofiltration6.4-6.86% solution: 10% sucrose, < 20 mg NaCl/g proteinLyophilized powder 3%, 6%, 9%, 12%Trace
Flebogamma



(Grifols USA)



Cohn-Oncley fractionation, PEG precipitation, ion-exchange chromatography, pasteurization5.1-6Sucrose free, contains 5% D-sorbitolLiquid 5%< 50
Gammagard Liquid 10%



(Baxter Bioscience)



Cohn-Oncley cold ethanol fractionation, cation and anion exchange chromatography, solvent detergent treated, nanofiltration, low pH incubation 4.6-5.10.25M glycineReady-for-use Liquid 10%37
Gamunex



(Talecris Biotherapeutics)



Cohn-Oncley fractionation, caprylate-chromatography purification, cloth and depth filtration, low pH incubation4-4.5Does not contain carbohydrate stabilizers (eg, sucrose, maltose), contains glycineLiquid 10%46
Gammaplex



(Bio Products)



Solvent/detergent treatment targeted to enveloped viruses; virus filtration using Pall Ultipor to remove small viruses including nonenveloped viruses; low pH incubation 4.8-5.1Contains sorbitol (40 mg/mL); do not administer if fructose intolerantReady-for-use solution 5%< 10
Iveegam EN



(Baxter Bioscience)



Cohn-Oncley fraction II/III; ultrafiltration; pasteurization6.4-7.25% solution: 5% glucose, 0.3% NaClLyophilized powder 5%< 10
Polygam S/D



Gammagard S/D



(Baxter Bioscience for the American Red Cross)



Cohn-Oncley cold ethanol fractionation, followed by ultracentrafiltration and ion exchange chromatography; solvent detergent treated 6.4-7.25% solution: 0.3% albumin, 2.25% glycine, 2% glucoseLyophilized powder 5%, 10%< 1.6 (5% solution)
Octagam



(Octapharma USA)



9/24/10: Withdrawn from market because of unexplained reports of thromboembolic events



Cohn-Oncley fraction II/III; ultrafiltration; low pH incubation; S/D treatment pasteurization5.1-610% maltoseLiquid 5%200
Panglobulin



(Swiss Red Cross for the American Red Cross)



Kistler-Nitschmann fractionation; pH 4 incubation, trace pepsin, nanofiltration6.6Per gram of IgG: 1.67 g sucrose, < 20 mg NaClLyophilized powder 3%, 6%, 9%, 12%720
Privigen Liquid 10%



(CSL Behring)



Cold ethanol fractionation, octanoic acid fractionation, and anion exchange chromatography; pH 4 incubation and depth filtration4.6-5L-proline (approximately 250 mmol/L) as stabilizer; trace sodium; does not contain carbohydrate stabilizers (eg, sucrose, maltose) Ready-for use liquid 10%< 25
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