Choosing Wisely

Immunoglobulin Replacement Therapy

When you need it—and when you don’t

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Some people suffer from repeated and severe infections because their immune system can’t make enough germ-fighting antibodies. A treatment known as immunoglobulin replacement (IgG) therapy can be a lifesaver for them. But other people receive the treatment even though they don’t need it. That’s not a good idea. Here’s why.

The treatment doesn’t help most people with frequent infections.

About one in 1,200 people in the U.S. have a disorder known as PIDD, or primary immunodeficiency disease. They often have multiple, hard-to-cure attacks of pneumonia, sinusitis, and other infections, because they lack IgG antibodies—the body’s chief weapon against bacterial infection—as well as other types of antibodies. IgG therapy can eliminate most of their infections. But it doesn’t help people whose immune system already makes enough antibodies. In fact, it isn’t even helpful for every form of PIDD. For example, people who lack only immunoglobulin A (IgA) antibodies don’t benefit because they still have adequate levels of IgG. And it’s usually not necessary for people who are short on just a type of IgG antibody, because they often make enough to ward off infections or control them with antibiotics.

It can pose risks.

The treatment involves injections of IgG antibodies into a vein or under the skin. Though side effects are more common with vein injections, both can cause a serious allergic reaction, kidney failure, or headache and flu-like symptoms. In rare cases, patients with severe headaches can have irritation of the lining around the brain. Swelling, bruising, or infection can occur at the injection site. Finally, treatment is made from blood of human donors, so it carries a remote risk of transmitting viruses.

It can be expensive.

The cost of treatment depends on the dose, your body weight, and where you have the injections. But either procedure can cost more than $30,000 a year. Because the treatment provides only temporary protection, it must be repeated regularly and usually for the patient’s whole life.

So when is the treatment warranted?

People with severe, frequent, unusual, or persistent infections should have a blood test to measure their antibody levels, and may be given the pneumonia vaccine and a booster shot for tetanus and diphtheria. If they don’t make antibodies in response to the shots, treatment might be a good idea. It’s also justified for people who have very low blood levels of IgG, and for those diagnosed with certain immune disorders.


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Published by Consumer Reports © 2012 Consumers Union of U.S., Inc., 101 Truman Ave., Yonkers, NY 10703-1057. Developed in cooperation with AAAAI for Choosing Wisely, a project of the ABIM Foundation. Portions of this report are derived from AAAAI’s “Five Things Physicians and Patients Should Question” list.

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