Best Practices and Guidelines in Immunoglobulin Therapy

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Immunoglobulin (Ig) therapy is a biologic treatment composed of pooled antibodies derived from human plasma used to treat immunodeficiency disorders. It offers immunomodulatory effects against a wide range of autoimmune, infectious, and inflammatory conditions.^1,2 Evidence-based guidelines support the safe and effective administration of Ig therapy in clinical practice. Optimizing Ig therapy through evidence-based practice allows clinicians to combine the latest scientific research with clinical expertise and patient preferences, ensuring high-quality, informed patient care.^2,3

Ig therapy can be delivered through various routes, each with specific considerations²:

• Intravenous immunoglobulin (IVIG) is administered every 3 to 4 weeks in hospitals, infusion centers, clinics, or at home. It rapidly reaches peak Ig levels but has a higher risk of systemic adverse reactions than other routes, requiring continuous clinician oversight.
• Subcutaneous immunoglobulin (SCIG) is administered in divided doses daily, weekly, or biweekly via subcutaneous infusion. It maintains stable IgG levels and has fewer systemic reactions than IVIG but may cause local site reactions.
• Facilitated SCIG (fSCIG) uses subcutaneous recombinant human hyaluronidase followed by IVIG, allowing larger doses every 2 to 4 weeks.

Although Ig therapy is typically safe and effective, it can lead to adverse reactions that range from mild to life-threatening. Common adverse effects include headaches, chills, fever, fatigue, muscle and joint pain, nausea, and vomiting, whereas severe reactions may involve kidney dysfunction, blood clots, anaphylaxis, or hemolytic anemia.^2,4 Clinicians can manage or prevent adverse reactions through pre-infusion assessment of the patient, pre-medication, controlled infusion rates, proper hydration, and continuous monitoring during infusion.² By comparing administration routes and adverse effects, clinicians can make informed decisions to optimize patient care.

Home-based Ig therapy offers a practice- and patient-centered approach for individuals requiring long term treatment. Key considerations include patient admission criteria, exclusion criteria, the role of home care nurses, and the operational needs of home health agencies expanding their services to provide this therapy. Patients eligible for home administration must have stable medical conditions and a history of tolerating infusions without severe adverse reactions. Home care nurses are essential to overseeing IVIG infusions, evaluating patients before each session, managing adverse reactions, adjusting infusion rates, and educating patients on recognizing complications.

Study data published in Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice highlighted the benefits of integrating standard care into clinical practice. A 58-year-old patient receiving IVIG for chronic inflammatory demyelinating polyneuropathy experienced fatigue and reduced quality of life due to spending an entire day in the hospital every 4 weeks. After confirming she tolerated the therapy without severe adverse reactions, she transitioned to home-based IVIG. A home care nurse supervised her first at-home infusion, gradually increasing the infusion rate while adhering to standardized protocols. This case highlights how home-based IVIG therapy can improve patient outcomes while delivering individualized, patient-centered care.

Ig therapy is an essential treatment. By implementing these recommendations, clinicians can ensure high-quality, patient-centered care that meets standards.

REFERENCES

1. Arumugham VB, Rayi A. Intravenous Immunoglobulin (IVIG). In: StatPearls [Internet]. Treasure Island (FL): July 2023.

2. Clarke A, Sobolevsky L. Immunoglobulin therapy and standards of practice. Home Healthc Now. 2025;43(2):69-77. doi:10.1097/NHH.00000000001330

3. Ig Therapy Standards of Practice. Immunoglobulin National Society. Accessed March 21, 2025. https://ig-ns.org/product/ig-therapy-standards-of-practice-version-3-2/#:~:text=Ig%20Therapy%20Standards%20of%20Practice%20(version%203.2)%20is%20Now%20Available,reader%20on%20your%20preferred%20device.

4. Kareva L, Mironska K, Stavric K, Hasani A. Adverse reactions to intravenous immunoglobulins – our experience. Open Access Maced J Med Sci. 2018;6(12):2359-2362. doi:10.3889/oamjms.2018.513