TREATMENT OF HYPOGAMMAGLOBULINEMIA WITH INTRAVENOUS IMMUNOGLOBULIN, 1973-93

Aims-To review the results of long term high dose intravenous immunogl obulin treatment. Methods-162 treatment years in 18 patients with hypo gammaglobulinaemia who received intravenous immunoglobulin treatment b etween 1973 and 1993 were reviewed. Results-A mean dose of 0.42 g/kg i mmunoglobulin resulted in a mean trough IgG concentration on the 23.5t h centile for age. The subjects enjoyed a good standard of health. Inf ection rates were similar to the general paediatric population and a s imilar pattern of infections occurred. There were only 0.06 episodes o f pneumonia and 0.11 hospital admissions per year of treatment. The de velopment of chronic pulmonary disease was significantly related to tr ough IgG concentrations less than the 10th centile (p < 0.009), howeve r, this developed in only two children after the start of treatment. A ll children had normal growth parameters. Adverse reactions to immunog lobulin infusions reduced from 9.1% to 0.8% after the introduction of low pH modified intravenous immunoglobulin in 1986. Although minor, tr ansient increases in liver transaminase values were common; none of th e 11 patients tested by hepatitis C polymerase chain reaction were pos itive. Conclusions-Children with hypogammaglobulinaemia who are receiv ing replacement treatment grow normally and have an infection rate sim ilar to that of non-immunodeficient children. No evidence of transmiss ion of hepatitis C virus by the Commonwealth Serum Laboratories immuno globulin was found.