Intravenous Immunoglobulins: Mechanism of Action and Limitations of Clinical Application in Pediatrics

• Main Author: S.O. Mokiia-Serbina
• Format: Article
• Language: English
• Published: Publishing House Zaslavsky 2016-02-01
• Series: Zdorovʹe Rebenka
• Subjects: children; immunoglobulin; replacement; immunomodulatory therapy
• Online Access: http://childshealth.zaslavsky.com.ua/article/view/73732
• ISSN: 2224-0551; 2307-1168

This review deals with an analysis of the available clinical studies and reports concerning the evaluation of the effectiveness and safety of intravenous immunoglobulins (IVIG) in various diseases in children. Intravenous immunoglobulins are drugs with a strictly regulated indications and proven efficacy and safety. Most often they are used for the correction of hypogammaglobulinemia, which is the result of a primary or secondary immunodeficiency (ID). To date, a large, but heterogeneous evidence base on the effectiveness of the standard IVIG in sepsis in children of different age groups is accumulated. IVIG consumption is increasing due to the fact that in many cases the drugs are being used off-label. IVIG were more likely to be used in autoimmune and systemic inflammatory diseases. However, in randomized clinical trials, a good effect was achieved only in Kawasaki disease and immune thrombocytopenic purpura. Current clinical guidelines narrowed the indications for IVIG, limiting their use in sepsis. Immunoglobulin replacement therapy is recommended for children with physiological delay of immunoglobulin production only in repeated infections, which can not be controlled or prevented with antibiotics. In secondary ID, replacement therapy must be carried out if the cause of hypogammaglobulinemia can not be eliminated or elimination is contraindicated, as well as in association with β-cell cancers, in which severe infections caused by encapsulated bacteria persist despite preventive antibiotic therapy.