Intravenous immunoglobulin

There has been a rapid expansion of the use of intravenous immunoglobulin ( IVIG) for an ever-growing number of conditions. IVIG is used at a 'replacement dose' (400-600 mg/kg/month) in antibody deficiencies. In contrast it is used at a high dose (2 g/kg/month) as an 'immunomodulatory' agent in an increasing number of immune and inflammatory disorders. The limitations for IVIG are the cost of the preparation and the need for intravenous infusions. Due to the cost, shortages and growing use of IVIG there have been attempts to develop evidence-based guidelines for the use of IVIG in a wide variety of haematological, autoimmune and neurological conditions. This commentary provides the recommendations and recent publication regarding the use of IVIG in various conditions. Although IVIG is a safe treatment option when compared with other immunosuppressive agents there needs to be an understanding of the potential adverse reactions and their management. It is important for the physician to carefully assess and monitor patients on IVIG so that treatment can be optimised.