Adverse reactions to intravenous immunoglobulin in primary immunodeficiency: a retrospective analysis

Introduction
Some diseases, including primary immunodeficiencies (PID), require treatment with intravenous immunoglobulin (IVIG). IVIG is an effective treatment and is generally well tolerated. IVIG can cause side effects ranging from mild reactions to, in rare cases, serious complications such as anaphylaxis.

Aim
We aimed to assess the frequency, types, and severity of adverse effects in adults receiving IVIG for PID, and to examine associated risk factors and the impact of premedication.

Material and methods
This retrospective cohort study analysed 90 patients and 6246 IVIG infusions administered at the Gülhane Training and Research Hospital between 2016 and 2024. Demographic data, comorbidities, IVIG-related side effects, and treatment processes of the patients were examined.

Results
A total of 6246 IVIG infusions were evaluated, 363 (5.8%) of which had side effects. Side effects mostly occurred within the first 6 h of infusion (early reaction) (75.2%). The most frequently preferred intervention was to reduce the infusion rate (37.5%), followed by stopping the treatment (27.5%) and using antihistamines (22.5%). Serious cases such as anaphylaxis were rare (0.12%) and could be controlled with appropriate interventions. The rate of side effects was significantly lower in patients who received premedication.

Conclusions
Our study highlights that side effects associated with IVIG treatment are generally mild and manageable, but careful monitoring and individualized premedication protocols are important for preventing side effects and patient safety.