Four-Year Experience with Serious Adverse Reactions to Intravenous γ-Globulin at a Tertiary Medical Center

Reports of the true incidence of adverse reactions to intravenous γ-globulin (IVIG) therapy are limited by the lack of studies documenting reactions in a large number of patients. The objective was to describe the frequency of serious side effects to intravenous immune globulin therapy at a major tertiary medical center between 1991 and 1995. A central pharmacy registry of a tertiary medical center was searched for all patients and doses of intravenous immune globulin therapy given in both the inpatient and outpatient setting. Records of patients were reviewed for specific details regarding an adverse reaction. Acute renal failure occurred in 2 of 194 (1%) patients and aseptic meningitis occurred in 4 of 194 (2%) patients. Renal failure occurred in 2 of 1637 (0.1%) of infusions and aseptic meningitis occurred in 5 of 1637 (0.3%) of infusions. Both cases of renal failure were adults receiving high doses (2 g/kg) of IVIG. Of the 4 patients who developed aseptic meningitis, 3 were adults and 1 was a child. Aseptic meningitis occurred in 3 patients receiving high dose and 1 patient receiving low dose (400 mg/kg) IVIG therapy. Acute renal failure and aseptic meningitis are rare side effects of IVIG therapy. Renal failure occurred only in adults with high-dose therapy. Possible risk factors for developing this complication include preexisting renal insufficiency, diabetes, older age, and concomitant diuretic use. Unlike previous studies, we found that aseptic meningitis can occur after administration with low doses of IVIG. (Pediatr Asthma Allergy Immunol 2000;14[4]:287-292.)