Abstract
Background: Intravenous Immunoglobulin (IVIg) forms a cornerstone of effective treatment for acute and chronic inflammatory neuropathies, with a class I evidence base in Guillain-Barré Syndrome (GBS), Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). It is generally considered to be a safe therapy however there are several recognised complications which are reviewed in this article.
Discussion and Conclusion: Most adverse events are immediate and mild such as headache, fever and nausea although more serious immediate reactions such as anaphylaxis may rarely occur. Delayed complications are rare but may be serious, including thromboembolic events and acute kidney injury, and these and associated risk factors are also discussed. We emphasise the importance of safe IVIg administration and highlight practical measures to minimise complications of this therapy.
Keywords: Adverse event, immunoglobulin, inflammatory neuropathy, IVIg, safety, GBS, CIDP, MMN.
Graphical Abstract
[1]
Jacob S, Rajabally YA. Immunomodulation in inflammatory neuropathies: Rationale and safety. Curr Drug Saf 2013; 8(4): 225-35.
[2]
Knezevic-Maramica I, Kruskall MS. Intravenous immune globulins: An update for clinicians. Transfusion 2003; 43(10): 1460-80.
[3]
Donofrio PD, Berger A, Brannagan TH, et al. Consensus statement: The use of intravenous immunoglobulin in the treatment of neuromuscular conditions report of the AANEM ad hoc committee. Muscle Nerve 2009; 40(5): 890-900.
[4]
Lunemann JD, Quast I, Dalakas MC. Efficacy of intravenous immunoglobulin in neurological diseases. Neurotherapeutics 2016; 13(1): 34-46.
[6]
Rajabally YA. Treatment of Guillain-Barre syndrome: A review. Inflamm Allergy Drug Targets 2012; 11(4): 330-4.
[7]
Hughes RA, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barre syndrome. Cochrane Database Syst Rev 2014; (9): CD002063.
[8]
Mathey EK, Park SB, Hughes RA, et al. Chronic inflammatory demyelinating polyradiculoneuropathy: From pathology to phenotype. J Neurol Neurosurg Psychiatry 2015; 86(9): 973-85.
[9]
Rajabally YA. Tailoring of therapy for chronic inflammatory demyelinating polyneuropathy. Neural Regen Res 2015; 10(9): 1399-400.
[10]
Eftimov F, Winer JB, Vermeulen M, de Haan R, van Schaik IN. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database Syst Rev 2013; (12): CD001797.
[11]
Oaklander AL, Lunn MP, Hughes RA, van Schaik IN, Frost C, Chalk CH. Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): An overview of systematic reviews. Cochrane Database Syst Rev 2017; 1: CD010369.
[12]
Adrichem ME, Eftimov F, van Schaik IN. Intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyradiculoneuropathy, a time to start and a time to stop. J Peripher Nerv Syst 2016; 21(3): 121-7.
[13]
Vlam L, van der Pol WL, Cats EA, et al. Multifocal motor neuropathy: Diagnosis, pathogenesis and treatment strategies. Nat Rev Neurol 2011; 8(1): 48-58.
[14]
Federico P, Zochodne DW, Hahn AF, Brown WF, Feasby TE. Multifocal motor neuropathy improved by IVIg: Randomized, double-blind, placebo-controlled study. Neurology 2000; 55(9): 1256-62.
[15]
Leger JM, Chassande B, Musset L, Meininger V, Bouche P, Baumann N. Intravenous immunoglobulin therapy in multifocal motor neuropathy: A double-blind, placebo-controlled study. Brain 2001; 124(Pt 1): 145-53.
[16]
Hahn AF, Beydoun SR, Lawson V, et al. A controlled trial of intravenous immunoglobulin in multifocal motor neuropathy. J Peripher Nerv Syst 2013; 18(4): 321-30.
[17]
Jacob S, Rajabally YA. Current proposed mechanisms of action of intravenous immunoglobulins in inflammatory neuropathies. Curr Neuropharmacol 2009; 7(4): 337-42.
[18]
Dezsi L, Horvath Z, Vecsei L. Intravenous immunoglobulin: Pharmacological properties and use in polyneuropathies. Expert Opin Drug Metab Toxicol 2016; 22: 1-16.
[19]
Elovaara I, Apostolski S, van Doorn P, et al. EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases: EFNS task force on the use of intravenous immunoglobulin in treatment of neurological diseases. Eur J Neurol 2008; 15(9): 893-908.
[20]
Ruzhansky K, Brannagan TH 3rd. Intravenous immunoglobulin for treatment of neuromuscular disease. Neurol Clin Pract 2013; 3(5): 440-5.
[21]
Stangel M, Kiefer R, Pette M, Smolka MN, Marx P, Gold R. Side effects of intravenous immunoglobulins in neurological autoimmune disorders--a prospective study. J Neurol 2003; 250(7): 818-21.
[22]
Wittstock M, Benecke R, Zettl UK. Therapy with intravenous immunoglobulins: Complications and side-effects. Eur Neurol 2003; 50(3): 172-5.
[23]
Caress JB, Kennedy BL, Eickman KD. Safety of intravenous immunoglobulin treatment. Expert Opin Drug Saf 2010; 9(6): 971-9.
[24]
Patwa HS, Chaudhry V, Katzberg H, Rae-Grant AD, So YT. Evidence-based guideline: Intravenous immunoglobulin in the treatment of neuromuscular disorders: Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 2012; 78(13): 1009-15.
[25]
Bonilla FA. Intravenous immunoglobulin: Adverse reactions and management. J Allergy Clin Immunol 2008; 122(6): 1238-9.
[26]
Stiehm ER. Adverse effects of human immunoglobulin therapy. Transfus Med Rev 2013; 27(3): 171-8.
[27]
Bertorini TE, Nance AM, Horner LH, Greene W, Gelfand MS, Jaster JH. Complications of intravenous gammaglobulin in neuromuscular and other diseases. Muscle Nerve 1996; 19(3): 388-91.
[28]
Cherin P, Marie I, Michallet M, et al. Management of adverse events in the treatment of patients with immunoglobulin therapy: A review of evidence. Autoimmun Rev 2016; 15(1): 71-81.
[29]
Nydegger UE, Sturzenegger M. Adverse effects of intravenous immunoglobulin therapy. Drug Saf 1999; 21(3): 171-85.
[30]
Orbach H, Katz U, Sherer Y, Shoenfeld Y. Intravenous immunoglobulin: Adverse effects and safe administration. Clin Rev Allergy Immunol 2005; 29(3): 173-84.
[31]
Abolhassani H, Sadaghiani MS, Aghamohammadi A, Ochs HD, Rezaei N. Home-based subcutaneous immunoglobulin versus hospital-based intravenous immunoglobulin in treatment of primary antibody deficiencies: Systematic review and meta-analysis. J Clin Immunol 2012; 32(6): 1180-92.
[32]
Fernandez AP, Kerdel FA. The use of i.v. IG therapy in dermatology. Dermatol Ther 2007; 20(4): 288-305.
[33]
Brannagan TH 3rd, Nagle KJ, Lange DJ, Rowland LP. Complications of intravenous immune globulin treatment in neurologic disease. Neurology 1996; 47(3): 674-7.
[34]
Hughes R, Bensa S, Willison H, et al. Randomized controlled trial of intravenous immunoglobulin versus oral prednisolone in chronic inflammatory demyelinating polyradiculoneuropathy. Ann Neurol 2001; 50(2): 195-201.
[35]
Vecchietti G, Kerl K, Prins C, Kaya G, Saurat JH, French LE. Severe eczematous skin reaction after high-dose intravenous immunoglobulin infusion: Report of 4 cases and review of the literature. Arch Dermatol 2006; 142(2): 213-7.
[36]
Sarmiento E, Micheloud D, Carbone J. Complement consumption associated with eczematous cutaneous reaction during infusions of high doses of intravenous immunoglobulin. Br J Dermatol 2004; 151(3): 721.
[37]
Donaghy M, Mills KR, Boniface SJ, et al. Pure motor demyelinating neuropathy: Deterioration after steroid treatment and improvement with intravenous immunoglobulin. J Neurol Neurosurg Psychiatry 1994; 57(7): 778-83.
[38]
Hamrock DJ. Adverse events associated with intravenous immunoglobulin therapy. Int Immunopharmacol 2006; 6(4): 535-42.
[39]
Burks AW, Sampson HA, Buckley RH. Anaphylactic reactions after gamma globulin administration in patients with hypogammaglobulinemia. Detection of IgE antibodies to IgA. N Engl J Med 1986; 314(9): 560-4.
[40]
Lunemann JD, Nimmerjahn F, Dalakas MC. Intravenous immunoglobulin in neurology--mode of action and clinical efficacy. Nat Rev Neurol 2015; 11(2): 80-9.
[42]
Rachid R, Bonilla FA. The role of anti-IgA antibodies in causing adverse reactions to gamma globulin infusion in immunodeficient patients: A comprehensive review of the literature. J Allergy Clin Immunol 2012; 129(3): 628-34.
[43]
Perez EE, Orange JS, Bonilla F, et al. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol 2017; 139(3S): S1-S46.
[44]
Dhami S, Sheikh A. Anaphylaxis: Epidemiology, aetiology and relevance for the clinic. Expert Rev Clin Immunol 2017; 13(9): 889-95.
[45]
Rizk A, Gorson KC, Kenney L, Weinstein R. Transfusion-related acute lung injury after the infusion of IVIG. Transfusion 2001; 41(2): 264-8.
[46]
Voulgari PV, Paschou S, Svarna E, Tsifetaki N, Drosos AA. Images in rheumatology. Transfusion-related acute lung injury during intravenous immunoglobulin treatment. J Rheumatol 2010; 37(1): 190-1.
[47]
Stoclin A, Delbos F, Dauriat G, et al. Transfusion-related acute lung injury after intravenous immunoglobulin treatment in a lung transplant recipient. Vox Sang 2013; 104(2): 175-8.
[48]
Quest GR, Gaal H, Clarke G, Nahirniak S. Transfusion-related acute lung injury after transfusion of pooled immune globulin: A case report. Transfusion 2014; 54(12): 3088-91.
[49]
Reddy DR, Guru PK, Blessing MM, Stubbs JR, Rabinstein AA, Wijdicks EF. Transfusion-Related acute lung injury after IVIG for myasthenic crisis. Neurocrit Care 2015; 23(2): 259-61.
[50]
Gajic O, Gropper MA, Hubmayr RD. Pulmonary edema after transfusion: How to differentiate transfusion-associated circulatory overload from transfusion-related acute lung injury. Crit Care Med 2006; 34(5)(Suppl.): S109-13.
[51]
Azizi G, Abolhassani H, Asgardoon MH, et al. Managing patients with side effects and adverse events to immunoglobulin therapy. Expert Rev Clin Pharmacol 2016; 9(1): 91-102.
[52]
Wallis JP, Lubenko A, Wells AW, Chapman CE. Single hospital experience of TRALI. Transfusion 2003; 43(8): 1053-9.
[53]
Henneman EA, Andrzejewski C Jr, Gawlinski A, McAfee K, Panaccione T, Dziel K. Transfusion-Associated circulatory overload: Evidence-based strategies to prevent, identify, and manage a serious adverse event. Crit Care Nurse 2017; 37(5): 58-65.
[54]
Woodruff RK, Grigg AP, Firkin FC, Smith IL. Fatal thrombotic events during treatment of autoimmune thrombocytopenia with intravenous immunoglobulin in elderly patients. Lancet 1986; 2(8500): 217-8.
[55]
Funk MB, Gross N, Gross S, et al. Thromboembolic events associated with immunoglobulin treatment. Vox Sang 2013; 105(1): 54-64.
[56]
Marie I, Maurey G, Herve F, Hellot MF, Levesque H. Intravenous immunoglobulin-associated arterial and venous thrombosis; report of a series and review of the literature. Br J Dermatol 2006; 155(4): 714-21.
[57]
Caress JB, Hobson-Webb L, Passmore LV, Finkbiner AP, Cartwright MS. Case-control study of thromboembolic events associated with IV immunoglobulin. J Neurol 2009; 256(3): 339-42.
[58]
Rajabally YA, Kearney DA. Thromboembolic complications of intravenous immunoglobulin therapy in patients with neuropathy: A two-year study. J Neurol Sci 2011; 308(1-2): 124-7.
[59]
Ramirez E, Romero-Garrido JA, Lopez-Granados E, et al. Symptomatic thromboembolic events in patients treated with intravenous-immunoglobulins: Results from a retrospective cohort study. Thromb Res 2014; 133(6): 1045-51.
[60]
Dalakas MC. High-dose intravenous immunoglobulin and serum viscosity: Risk of precipitating thromboembolic events. Neurology 1994; 44(2): 223-6.
[61]
Ammann EM, Haskins CB, Fillman KM, et al. Intravenous immune globulin and thromboembolic adverse events: A systematic review and meta-analysis of RCTs. Am J Hematol 2016; 91(6): 594-605.
[62]
Paran D, Herishanu Y, Elkayam O, Shopin L, Ben-Ami R. Venous and arterial thrombosis following administration of intravenous immunoglobulins. Blood Coagul Fibrinolysis 2005; 16(5): 313-8.
[63]
Bentley P, Rosso M, Sadnicka A, Israeli-Korn S, Laffan M, Sharma P. Intravenous immunoglobulin increases plasma viscosity without parallel rise in blood pressure. J Clin Pharm Ther 2012; 37(3): 286-90.
[64]
Pollreisz A, Assinger A, Hacker S, et al. Intravenous immunoglobulins induce CD32-mediated platelet aggregation in vitro. Br J Dermatol 2008; 159(3): 578-84.
[65]
Sztajzel R, Le Floch-Rohr J, Eggimann P. High-dose intravenous immunoglobulin treatment and cerebral vasospasm: A possible mechanism of ischemic encephalopathy? Eur Neurol 1999; 41(3): 153-8.
[66]
Wolberg AS, Kon RH, Monroe DM, Hoffman M. Coagulation factor XI is a contaminant in intravenous immunoglobulin preparations. Am J Hematol 2000; 65(1): 30-4.
[68]
Ovanesov MV, Menis MD, Scott DE, et al. Association of immune globulin intravenous and thromboembolic adverse events. Am J Hematol 2017; 92(4): E44-5.
[69]
Lozeron P, Not A, Theaudin M, et al. Safety of intravenous immunoglobulin in the elderly treated for a dysimmune neuromuscular disease. Muscle Nerve 2016; 53(5): 683-9.
[70]
Huang L, Kanellis J, Mulley W. Slow and steady. Reducing thrombotic events in renal transplant recipients treated with IVIg for antibody-mediated rejection. Nephrology (Carlton) 2011; 16(2): 239-42.
[71]
Mignogna MD, Fortuna G, Leuci S, Ruoppo E, Adamo D, Fedele S. Analysis of thromboembolic risk related to high-dose intravenous immunoglobulin treatment: A preliminary clinical study of 10 patients with autoimmune mucocutaneous blistering diseases. Clin Exp Dermatol 2009; 34(2): 145-50.
[72]
Vo AA, Cam V, Toyoda M, et al. Safety and adverse events profiles of intravenous gammaglobulin products used for immunomodulation: A single-center experience. Clin J Am Soc Nephrol 2006; 1(4): 844-52.
[73]
Barton JC, Herrera GA, Galla JH, Bertoli LF, Work J, Koopman WJ. Acute cryoglobulinemic renal failure after intravenous infusion of gamma globulin. Am J Med 1987. 82(3 Spec No): 624-9.
[74]
Haskin JA, Warner DJ, Blank DU. Acute renal failure after large doses of intravenous immune globulin. Ann Pharmacother 1999; 33(7-8): 800-3.
[76]
Itkin YM, Trujillo TC. Intravenous immunoglobulin-associated acute renal failure: Case series and literature review. Pharmacotherapy 2005; 25(6): 886-92.
[77]
Daphnis E, Stylianou K, Alexandrakis M, et al. Acute renal failure, translocational hyponatremia and hyperkalemia following intravenous immunoglobulin therapy. Nephron Clin Pract 2007; 106(4): c143-8.
[78]
Centers for Disease C. Prevention. Renal insufficiency and failure associated with immune globulin intravenous therapy--United States, 1985-1998. MMWR Morb Mortal Wkly Rep 1999; 48(24): 518-21.
[79]
Fakhouri F. Intravenous immunoglobulins and acute renal failure: mechanism and prevention. Rev Med Interne 2007; 28(1): 4-6.
[80]
Lin RY, Rodriguez-Baez G, Bhargave GA, Lin H. Intravenous gammaglobulin-associated renal impairment reported to the FDA: 2004 - 2009. Clin Nephrol 2011; 76(5): 365-72.
[81]
Lakshmanadoss U, Balakrishnan E, DiSalle MR. Sucrose nephropathy following IV immunoglobulin. J Basic Clin Pharm 2010; 1(2): 125-7.
[82]
Dantal J. Intravenous immunoglobulins: In-depth review of excipients and acute kidney injury risk. Am J Nephrol 2013; 38(4): 275-84.
[83]
Welles CC, Tambra S, Lafayette RA. Hemoglobinuria and acute kidney injury requiring hemodialysis following intravenous immunoglobulin infusion. Am J Kidney Dis 2010; 55(1): 148-51.
[84]
Desborough MJ, Miller J, Thorpe SJ, Murphy MF, Misbah SA. Intravenous immunoglobulin-induced haemolysis: A case report and review of the literature. Transfus Med 2014; 24(4): 219-26.
[85]
Levine AA, Levine TD, Clarke K, Saperstein D. Renal and hematologic side effects of long-term intravenous immunoglobulin therapy in patients with neurologic disorders. Muscle Nerve 2017; 56(6): 1173-6.
[86]
Kemmotsu Y, Nakayama T, Matsuura H, Saji T. Clinical characteristics of aseptic meningitis induced by intravenous immunoglobulin in patients with Kawasaki disease. Pediatr Rheumatol Online J 2011; 9: 28.
[87]
Sekul EA, Cupler EJ, Dalakas MC. Aseptic meningitis associated with high-dose intravenous immunoglobulin therapy: Frequency and risk factors. Ann Intern Med 1994; 121(4): 259-62.
[88]
Bharath V, Eckert K, Kang M, Chin-Yee IH, Hsia CC. Incidence and natural history of intravenous immunoglobulin-induced aseptic meningitis: A retrospective review at a single tertiary care center. Transfusion 2015; 55(11): 2597-605.
[89]
Nettis E, Calogiuri G, Colanardi MC, Ferrannini A, Tursi A. Drug-induced aseptic meningitis. Curr Drug Targets Immune Endocr Metabol Disord 2003; 3(2): 143-9.
[90]
Constantinescu CS, Chang AP, McCluskey LF. Recurrent migraine and intravenous immune globulin therapy. N Engl J Med 1993; 329(8): 583-4.
[91]
Finkel AG, Howard JF Jr, Mann JD. Successful treatment of headache related to intravenous immunoglobulin with antimigraine medications. Headache 1998; 38(4): 317-21.
[92]
Berg R, Fuellenhals E. Aseptic meningitis following therapy with immune globulins: A combination of product features and patient characteristics? Transfusion 2016; 56(12): 3021-8.
[93]
Scott DE, Epstein JS. Hemolytic adverse events with immune globulin products: Product factors and patient risks. Transfusion 2015; 55(Suppl. 2): S2-5.
[94]
Mohamed M. Intravenous immunoglobulin-associated hemolysis: Risk factors, challenges, and solutions. Int J Clin Transfusion Med 2016; 4: 121-31.
[95]
Comenzo RL, Malachowski ME, Meissner HC, Fulton DR, Berkman EM. Immune hemolysis disseminated intravascular coagulation, and serum sickness after large doses of immune globulin given intravenously for Kawasaki disease. J Pediatr 1992; 120(6): 926-8.
[96]
Kahwaji J, Barker E, Pepkowitz S, et al. Acute hemolysis after high-dose intravenous immunoglobulin therapy in highly HLA sensitized patients. Clin J Am Soc Nephrol 2009; 4(12): 1993-7.
[97]
Scott DE, Epstein JS. Safeguarding immune globulin recipients against hemolysis: What do we know and where do we go? Transfusion 2015; 55(Suppl. 2): S122-6.
[98]
Berg R, Shebl A, Kimber MC, Abraham M, Schreiber GB. Hemolytic events associated with intravenous immune globulin therapy: A qualitative analysis of 263 cases reported to four manufacturers between 2003 and 2012. Transfusion 2015; 55(Suppl. 2): S36-46.
[99]
Spath PJ, Granata G, La Marra F, Kuijpers TW, Quinti I. On the dark side of therapies with immunoglobulin concentrates: The adverse events. Front Immunol 2015; 6: 11.
[100]
Ben-Chetrit E, Putterman C. Transient neutropenia induced by intravenous immune globulin. N Engl J Med 1992; 326(4): 270-1.
[101]
Matsuda M, Hosoda W, Sekijima Y, et al. Neutropenia as a complication of high-dose intravenous immunoglobulin therapy in adult patients with neuroimmunologic disorders. Clin Neuropharmacol 2003; 26(6): 306-11.
[102]
Lawn N, Wijdicks EF, Burritt MF. Intravenous immune globulin and pseudohyponatremia. N Engl J Med 1998; 339(9): 632.
[103]
Steinberger BA, Ford SM, Coleman TA. Intravenous immunoglobulin therapy results in post-infusional hyperproteinemia, increased serum viscosity, and pseudohyponatremia. Am J Hematol 2003; 73(2): 97-100.
[104]
Mignogna MD, Fortuna G, Ruoppo E, Adamo D, Leuci S, Fedele S. Variations in serum hemoglobin, albumin, and electrolytes in patients receiving intravenous immunoglobulin therapy: A real clinical threat? Am J Clin Dermatol 2007; 8(5): 291-9.
[105]
Nguyen MK, Rastogi A, Kurtz I. True hyponatremia secondary to intravenous immunoglobulin. Clin Exp Nephrol 2006; 10(2): 124-6.
[106]
Winiecki S, Baer B, Chege W, et al. Complementary use of passive surveillance and Mini-Sentinel to better characterize hemolysis after immune globulin. Transfusion 2015; 55(Suppl. 2): S28-35.
[107]
Steinberger B, Coleman TA. Multiple complications of IVIG therapy in a patient with Guillain-Barre syndrome. Am J Hematol 2001; 67(1): 59.
[108]
Liamis G, Liberopoulos E, Barkas F, Elisaf M. Spurious electrolyte disorders: A diagnostic challenge for clinicians. Am J Nephrol 2013; 38(1): 50-7.
[109]
Saifudheen K, Jose J, Gafoor VA, Musthafa M. Guillain-Barre syndrome and SIADH. Neurology 2011; 76(8): 701-4.
[110]
Centers for Disease C. Prevention. Outbreak of hepatitis C associated with intravenous immunoglobulin administration--United States, October 1993-June 1994. MMWR Morb Mortal Wkly Rep 1994; 43(28): 505-9.
[111]
Gardulf A, Nicolay U, Asensio O, et al. Rapid subcutaneous IgG replacement therapy is effective and safe in children and adults with primary immunodeficiencies--a prospective, multi-national study. J Clin Immunol 2006; 26(2): 177-85.
[112]
Ochs HD, Gupta S, Kiessling P, Nicolay U, Berger M, Subcutaneous Ig GSG. Safety and efficacy of self-administered subcutaneous immunoglobulin in patients with primary immunodeficiency diseases. J Clin Immunol 2006; 26(3): 265-73.
[113]
Markvardsen LH, Christiansen I, Andersen H, Jakobsen J. Headache and nausea after treatment with high-dose subcutaneous versus intravenous immunoglobulin. Basic Clin Pharmacol Toxicol 2015; 117(6): 409-12.
[114]
Eijkhout HW, van den Broek PJ, van der Meer JW. Substitution therapy in immunodeficient patients with anti-IgA antibodies or severe adverse reactions to previous immunoglobulin therapy. Neth J Med 2003; 61(6): 213-7.
[115]
Horn J, Thon V, Bartonkova D, et al. Anti-IgA antibodies in common variable immunodeficiency (CVID): Diagnostic workup and therapeutic strategy. Clin Immunol 2007; 122(2): 156-62.
[116]
Vacchiano V, Liguori R, Pasini E, Avoni P, Donadio V. Subcutaneous immunoglobulin treatment and thromboembolic risk. Ann Allergy Asthma Immunol 2018; 120(4): 433-5.
[117]
Berger M. Subcutaneous immunoglobulin replacement in primary immunodeficiencies. Clin Immunol 2004; 112(1): 1-7.
[118]
Racosta JM, Sposato LA, Kimpinski K. Subcutaneous versus intravenous immunoglobulin for chronic autoimmune neuropathies: A meta-analysis. Muscle Nerve 2017; 55(6): 802-9.
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