الفهرس 
Immunoglobulins proteinsOnly 14 pages are availabe for public view
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Abstract
IVIgs are obtained from pooled human sera harvested from thousands of donors. Products suitable for intramuscular application were developed 40 years ago for prophylaxis and treatment of viral diseases, while Igs suitable for intravenous application were introduced in the early 1980s to help use of larger doses for broader therapeutic uses.
The usage of IVIgs must be done carefully and with more attention by the doctor towards his patient, in order to avoid or decrease IVIgs side effects and increase its benefits. Also anyone who has had unusual reactions to drugs used in immunologic therapy should let his or her doctor know before taking the drugs again. The doctor should also be told about any allergies to foods, dyes, preservatives, and other substances.
Basline laboratory testing is recommended before IVIg therapy. These tests include complete blood picture, liver function tests, serum immunoglobulin and pemphigus antibody levels, and screening tests for HIV, and hepatitis A, B, and C viruses. Cross-matching is also recommended to eliminate anaphylactic or immune-mediated adverse reactions. Also other tests may be needed in order to avoid any side effects or complications of IVIg therapy.
IVIg therapy should be avoided in patients with a history of migraine and recent coronary or cerebrovascular disease, old patients and those with renal insufficiency, immunoglobulin A deficiency, chronic infection, paraproteinaemia or hyperlipo-proteinaemia.
IVIg is a relatively expensive modality of treatment so that it is not the first line treatment in many diseases but it is used mainly in severe recalcitrant cases or in patients who have contraindications or side effects from using systemic corticosteroids or immunosuppressive drugs.
Intravenous immunoglobulin is a sterile solution composed of heterogenous human IgG with trace amount of IgA and IgM. Several processes are performed during manufacturing in order to guard against infection.
The recommended dose of IVIg is 1-2g/kg, divided on five days cycle of(0.4mg/kg/day) and each infusion is given over 4-4.5 hours. Cycles are repeated monthly as IVIgs half-life is about 18 to 32 days. Administration is repeated untill there is effective disease control.
IVIg is used in autoimmune blistering diseases such as pemphigus, pemphigoid group, linear IgA and epidermolysis bullosa aquisita,severe drug reactions such as TEN and SJS syndromes, and other dermatologic disorders such as atopic dermatitis, dermatomyositis, scleroderma and Kawasaki disease giving good results as reported in different studies.
The role of IVIg in autoimmune and inflammatory dermatoses continues to gain support. Case report of its use are appearing with increasing frequency. Nevertheless, carefully designed pros-pective randomized clinical trials are still lacking.
Advantages of treatment with IVIg resides in its relative safety. Immunosuppression with cytotoxic drugs is not required. Dastardly prednisone therapy may be avoided or stopped in some patients.
Lastly IVIg treatment is still experimental, it seems to be effective but the actual degree and length of effectiveness and the optimum dosages and intervals are still being determined. Adequate and frequent medical supervision of treatment is necessary.
Adequately controlled long - term clinical trials are required to determine guidelines concerning duration, dose, frequency, mode of application. The increasing knowledge concerning the underlying mechanisms responsible for the beneficial effects of IVIg in the treatment of autoimmune disease will ultimately help to optimize the use of this promising therapeutic approach.