PMID- 16682800
OWN - NLM
STAT- MEDLINE
DCOM- 20060713
LR  - 20060613
IS  - 1018-2438 (Print)
IS  - 1018-2438 (Linking)
VI  - 140
IP  - 3
DP  - 2006
TI  - Intravenous immunoglobulin: striving for appropriate use.
PG  - 185-98
AB  - BACKGROUND: Intravenous immunoglobulin (IVIG) is the mainstay therapy in human 
      immune deficiency states characterized by qualitative and quantitative reductions 
      in B cells. In addition, however, there is widespread use of IVIG in a number of 
      other areas, including neuroimmunologic, infectious, dermatologic, hematologic, 
      autoimmune, inflammatory and idiopathic disorders. In many of these cases, there 
      are little objective data to support the use. METHODS: We performed a review of 
      more than 400 publications in PubMed using the key words 'intravenous 
      immunoglobulin' and excluded publications that focused on immune deficiency, for 
      which the indication for IVIG is already clear. RESULTS: For a number of 
      off-label indications, there is significant evidence of efficacy and IVIG has 
      become the standard of care for many clinical syndromes other than immune 
      deficiency. In some conditions, however, the data have not been well controlled 
      or randomized and are often limited to case reports that are difficult to 
      interpret. Although the critical shortage of IVIG of the last decade is no longer 
      an issue, IVIG is expensive and not without risk. The use of IVIG should be based 
      not only on clinical data, but also, and especially, on the biological rationale 
      for its use. CONCLUSIONS: The appropriate use of IVIG is an important issue that 
      is difficult to resolve, and will continue to challenge clinicians based on 
      expense and potentially limited supply, including the intrinsic limitations of 
      donor plasma. The establishment of national and international voluntary 
      registries to report use of IVIG in disorders for which evidence is lacking would 
      be a first step toward facilitating randomized, controlled clinical trials.
FAU - Kumar, Arvind
AU  - Kumar A
AD  - Division of Rheumatology, Allergy and Clinical Immunology, Department of Internal 
      Medicine,University of California at Davis School of Medicine, Davis, Calif. 
      95616, USA.
FAU - Teuber, Suzanne S
AU  - Teuber SS
FAU - Gershwin, M Eric
AU  - Gershwin ME
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20060508
PL  - Switzerland
TA  - Int Arch Allergy Immunol
JT  - International archives of allergy and immunology
JID - 9211652
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Autoimmune Diseases of the Nervous System/therapy
MH  - Dermatomyositis/therapy
MH  - Guillain-Barre Syndrome/therapy
MH  - Humans
MH  - Immunoglobulins, Intravenous/standards/*therapeutic use
MH  - Immunologic Deficiency Syndromes/*therapy
MH  - Immunotherapy/*methods/standards
MH  - Stiff-Person Syndrome/therapy
RF  - 98
EDAT- 2006/05/10 09:00
MHDA- 2006/07/14 09:00
CRDT- 2006/05/10 09:00
PHST- 2006/05/10 09:00 [pubmed]
PHST- 2006/07/14 09:00 [medline]
PHST- 2006/05/10 09:00 [entrez]
AID - 93204 [pii]
AID - 10.1159/000093204 [doi]
PST - ppublish
SO  - Int Arch Allergy Immunol. 2006;140(3):185-98. doi: 10.1159/000093204. Epub 2006 
      May 8.