Intravenous immunoglobulin (IVIg)

Immunoglobulins are the antibodies produced naturally by the body’s immune system, which help fight infection and disease.

Intravenous immunoglobulin, or IVIg, is a treatment that combines immunoglobulins (im-yoo-no-glob-yoo-lins) donated by different people to treat various conditions. Intravenous means that it is given by a drip.

IVIg and other immunoglobulins are made from plasma. You can find out more about donating plasma on the NHS Give blood site.

IVIg is used to reduce the effects of some inflammatory conditions that involve the immune system, also known as autoimmune diseases. It’s also used to increase levels of immunoglobulins if these are low, or have been lowered by treatment with other drugs, such as rituximab.

IVIg isn’t very commonly used in the UK, and you may only be given it if other treatments haven’t worked. It may be used in the treatment of several different conditions, including:

• myositis
• lupus
• adult-onset Still's disease
• systemic juvenile idiopathic arthritis
• vasculitis
• antiphospholipid syndrome
• people with certain complications due to Sjögren’s syndrome.

IVIg should start to work within a few weeks, but this will vary depending on which condition you have and how you respond to the treatment. If IVIg works for you, the effects can last for a few months.

Before you start IVIg, your doctor will check the levels of immunoglobulins in your blood. If one type of immunoglobulin, known as IgA, is very low, then you may not be given IVIg.

You might not be given IVIg if you've had a previous reaction to immunoglobulin, and you may not be able to have some types of IVIg if you have an intolerance to fruit sugar.

There’s currently a shortage in the supply of IVIg, so for some conditions you’ll only be given it if you’ve tried certain other treatments first, and if those treatments haven’t worked for you.

IVIg is given through a drip into a vein, this is known as intravenous infusion. It is sometimes given as an injection into a muscle if you’re only taking it to increase your immunoglobulin levels following other treatments.

You’ll need to go to a hospital each time you have the treatment. The infusion will take several hours as the drug has to be given slowly. You’ll have your blood pressure, pulse and temperature checked regularly while you’re having the drip, to monitor your body’s reaction.

If you don’t have any problems during the first hour of the infusion, the rate will be increased by the doctor or nurse looking after you. After it’s finished, you’ll need to be observed at the hospital for an hour to check for any side effects.

How often you have IVIg infusions will depend on the condition you have and how you respond to the treatment. The dose will be calculated based on your weight.

People having IVIg occasionally have a reaction during or after the infusion. The symptoms of this include:

• a chill or a fever
• headache
• stomach pain
• feeling sick or vomiting
• joint pain
• low back pain
• tiredness.

If these symptoms happen during the infusion, it will be slowed down or stopped. The symptoms normally settle quickly.

You’ll be monitored while you’re having the treatment, but you should report any new symptoms during or after the infusion to a healthcare professional.

You’ll usually be given the same brand of IVIg, such as Flebogamma or Octagam, every time you have it to reduce the likelihood of a reaction.

All blood donors for IVIg are carefully tested for certain diseases that could be passed on to you, such as hepatitis B, and they are only able to donate if their blood is safe. However, it's impossible to completely rule out the risk of passing on some infections.

Sometimes people having IVIg may experience the following side effects, but all of these can be treated:

• a rash
• liver problems
• kidney failure
• inflammation of the brain, known as aseptic meningitis
• haemolytic anaemia, a condition with different causes, that destroys red blood cells.

Very rarely, people may experience a severe allergic reaction to IVIg during the infusion. If you experience any of the following symptoms, you should let the person managing your infusion know:

• chest tightness
• breathing difficulties
• a rash
• swelling of the face or tongue
• a drop in blood pressure.

IVIg can sometimes cause a rise in blood pressure, which can lead to an increase in the risk of heart attack or stroke. It can also increase the risk of blood clots.

If you have any concerns about your treatment or its side effects, you should discuss these with your doctor, rheumatology nurse or pharmacist.

You should be fine to take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and painkillers along with IVIg. Always check with your doctor before starting any new treatments and remember to mention you're taking IVIg if you're treated by anyone other than your usual rheumatology team.

IVIg doesn’t usually affect other drugs, but you should tell your doctor which medicines you’re currently taking. Don’t use complementary treatments, such as herbal remedies, without discussing this first with your doctor or pharmacist as some of them could react with IVIg.

Vaccinations

It’s best to discuss vaccinations with your healthcare team before starting IVIg.

IVIg may affect how your immune system reacts following any vaccination, and this can make the vaccine less effective. Because of this, it is best to avoid vaccinations for at least six weeks after having IVIg. You will need to avoid live vaccines for three weeks before having IVIg, and for three months afterwards.

It’s recommended that you have the vaccination against COVID-19, the pneumonia vaccine and yearly flu vaccine injection while taking IVIg. These vaccines are not live, so it is safe for you to have them.

Speak to your doctor for advice before having any vaccinations.

Having an operation

Talk this over with your surgeon or doctor. You may be able to continue, but your doctor might need to make changes to your dose or the timing of your IVIg treatment.

There's no need to avoid alcohol before or after IVIg treatment.

Guidelines state that adults shouldn’t have more than 14 units a week, and that they should spread them out over the course of the week. In some circumstances your doctor may advise lower limits.

Current guidelines say that IVIg can be given during pregnancy and breastfeeding because it’s not been shown to have harmful effects on the mother or baby.

We’re not sure yet how IVIg might affect men trying to father a child. Because it’s not harmful in pregnant women, it is unlikely to be harmful to men hoping to father a child.