Transient Hypogammaglobulinemia of Infancy Medication

Updated: Aug 26, 2016
  • Author: Alan P Knutsen, MD; Chief Editor: Harumi Jyonouchi, MD  more...
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Medication

Medication Summary

Choose antibiotics to cover S pneumoniae, H influenzae, and Moraxella catarrhalis (eg, amoxicillin, second-generation cephalosporins, clarithromycin). Often, prophylactic antibiotics decrease infections. IVIG is rarely needed and is used only when the patient continues to have infections despite antibiotics.

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Immunoglobulins

Class Summary

IVIG or subcutaneous immune globulin is used for antibody replacement therapy.

Immune globulin, intravenous (Carimune NF, Gammagard S/D, Gammagard liquid, Gammar-P, Gammaplex, Gamunex, Optigam, Polygam S/D, Privigen)

Purified preparation of gamma globulin derived from large pools of human plasma. Comprises 4 antibody subclasses.

Potential adverse effects include allergic reactions (eg, anaphylaxis, urticaria) because of IgE or anti-IgA antibodies. In a risk-benefit analysis, allergic reactions with IVIG administration in THI probably warrant discontinuation of IVIG. In severe B-cell immunodeficiency diseases in which IVIG is critical to care, premedication with corticosteroids and antihistamines (diphenhydramine) is usually successful in avoiding a reaction. In addition, the different IVIG preparations contain different amounts of IgA. Select an IVIG preparation with the least amount of IgA (eg, Gammagard SD). Contact manufacturer for specific lots low in IgA.

Immune globulin, subcutaneous (Hizentra, Gammagard liquid, Gamunex c)

IgG antibodies that neutralize a wide variety of bacterial and viral agents. Neutralizes circulating myelin antibodies through anti-idiotypic antibodies; downregulates proinflammatory cytokines, including INF-gamma; blocks Fc receptors on macrophages; suppresses inducer T and B cells and augments suppressor T cells; blocks complement cascade. Peak serum IgG levels are lower and trough IgG levels are higher than those achieved with IVIG. SC administration results in stable steady-state IgG levels when administered weekly. Hizentra is a 20% (ie, 200-mg/mL) SC injectable and Gammagard liquid and Gamunex c are 10% (ie, 100 mg/mL) SC injectables.

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Vaccines

Class Summary

These agents are used to induce active immunity.

Pneumococcal 7-valent conjugate vaccine (Prevnar)

Sterile solution of saccharides of capsular antigens of S pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F individually conjugated to diphtheria CRM197 protein. These 7 serotypes have been responsible for >80% of invasive pneumococcal disease in children < 6 years in the United States. Also accounted for 74% of penicillin-nonsusceptible S pneumoniae (PNSP) infections and 100% of pneumococci infections with high-level penicillin resistance. Customary age for first dose is 2 mo, but can be given as young as 6 wk.

Preferred sites of IM injection include the anterolateral aspect of the thigh in infants or deltoid muscle of upper arm in toddlers and young children. Do not inject vaccine in gluteal area or areas where there may be a major nerve trunk or blood vessel.

Number of 0.5 mL doses for series initiated at age 7-11 mo is 3 (4 wk apart; third dose after first birthday), at age 12-23 mo is 2 doses (2 mo apart), for age 2-9 y is one dose.

Minor illnesses, such as a mild upper respiratory tract infection, with or without low-grade fever are not generally contraindications.

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