Subcutaneous IVIg                 Worlds TOP SITE ON IVIG (Read our IVIg page)

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a subcutaneous needle inserted in tissue. Subcutaneous IVIg infusion sets are available . these multi site subcutaneous administration sets  help speed up the subcutaneous infusion. A subcutaneous IVIg is available for infusion called Via SCIG Delivery subcutaneous Sets are designed specifically for the administration of IgG (Immunoglobulin) where multiple infusion sites are needed. The SCIG Infusion Set allows for multiple subcutaneous infusion sites connected to one common tube for connection to an infusion pump. The SCIG Extension Set allows for connection to multiple needle sets while still allowing for connection to one common tube, for connection to an infusion pump.     Pediatric Asthma, Allergy & Immunology Aseptic Meningitis Due to Intravenous Immunoglobulin Therapy That Resolved with Subcutaneous Administration Dec 2000, Vol. 14, No. 4: 323-327 Michael R. Nelson, MD Allergy-Immunology Department, Walter Reed Army Medical Center, Washington D.C.; Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland. Allergy-Immunology Department, Walter Reed Army Medical Center, Washington D.C.; Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland. Aseptic meningitis is a rare but well recognized severe complication of high-dose intravenous immunoglobulin (IVIG) therapy. We report the case of a 9-year-old female who presented with functional hypogammaglobulinemia and recurrent sinopulmonary infections refractory to antibiotic prophylaxis. She was started on replacement dose IVIG therapy that was complicated by the development of headache, nuchal rigidity, photophobia, fever, nausea, vomiting, and lethargy after most infusions. Clinical evaluation and two cerebrospinal fluid analyses were consistent with aseptic meningitis. Interventions such as slower rates, in-line filters, dilute preparations, manufacturer change, and pretreatment were largely ineffective. The addition of post-IVIG oral corticosteroids attenuated the severity of symptoms, but the patient's quality-of-life and school attendance continued to suffer. In light of a continued need for therapy, mounting intravenous access difficulties, and requirement for frequent high dose corticosteroids, a trial of subcutaneous immunoglobulin infusion was initiated. She has tolerated this therapy for more than 3 years without serious adverse effects or need for corticosteroids, and continues to achieve clinical benefit by this route. A recent rechallenge with IVIG resulted in recurrent symptoms. Disabling aseptic meningitis and severe headache are rare complications of replacement-dose IVIG. It is noteworthy that aseptic meningitis has been previously described for replacement IVIG therapy in only one other child, but the refractory nature of this side effect in the index case described is unique in the literature. Subcutaneous immunoglobulin infusion is an effective and well-tolerated alternative to IVIG, especially in the setting of recurrent aseptic meningitis. (Pediatr Asthma Allergy Immunol 2000;14[4]:323327.

            Standard IVIG infusion

Subcutaneous Infusion leads to a improved IgG level.

Above slides from Melvin Berger MD Case Western Reserve University

  Subcutaneous immunoglobulin replacement in patients with primary antibody deficiencies: safety and costs.

Gardulf A, Andersen V, Bjorkander J, Ericson D, Froland SS, Gustafson R, Hammarstrom L, Jacobsen MB, Jonsson E, Moller G, et al.

Department of Clinical Immunology, Karolinska Institute, Huddinge University Hospital, Sweden.

Immunoglobulins (IgG) as replacement therapy in primary antibody deficiencies can be given as intramuscular injections, or as intravenous or subcutaneous infusions. Our aims were to obtain information on the frequency of adverse systemic reactions during subcutaneous therapy, the occurrence and intensity of tissue reactions at the infusion sites, and serum IgG changes. Furthermore, we compared costs between the different replacement regimes. Our study included 165 patients (69 women, 96 men, aged 13-76 years) with primary hypogammaglobulinaemia or IgG-subclass deficiencies. Data were compiled from questionnaires filled in by the patients and from their medical records. 33,168 subcutaneous infusions (27,030 in home therapy) had been given. 106 (of which 16 were at home) adverse systemic reactions (100 mild, 6 moderate) were recorded in 28 patients (17%). No severe or anaphylactoid reactions occurred. Despite large immunoglobulin volumes given during 434 patient years (28,480 infusions), no signs have been found that indicate the transmission of hepatitis virus. Transient tissue reactions occurred at the infusion sites but were not troublesome to most patients and we found significant increases in mean serum IgG. The use of subcutaneous instead of intravenous infusions at home would reduce the yearly cost per patient for the health-care sector by US $10,100 in Sweden alone. We conclude that subcutaneous administration of IgG is a safe and convenient method of providing immunoglobulins. We were able to reach serum IgG concentrations similar to those by the intravenous therapy and we found that the method could also be used successfully in patients with previous severe or anaphylactoid reactions to intramuscular injections.

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J Gaspar, B Gerritsen, A Jones

Department of Immunology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK

Correspondence to: J Gaspar or A Jones.
Accepted 7 January 1998