Immunoglobulin Therapy Complications and Management

Anaphylaxis and Immediate Reactions

The British Journal of Dermatology notes that anaphylactic reactions, though rare, represent the most serious immediate complication, occurring predominantly in IgA-deficient patients, and require immediate discontinuation of infusion with intramuscular epinephrine 0.2-0.5 mg in the lateral thigh 1
The American College of Physicians, as reported by Praxis Medical Insights, recommends stopping the infusion immediately and maintaining IV access in cases of anaphylaxis 3
Administering epinephrine 0.01 mg/kg IM (maximum 0.5 mg) in the lateral thigh, repeating every 5-15 minutes if needed, is advised by Praxis Medical Insights 2, 3
Providing oxygen and aggressive volume resuscitation with normal saline is recommended by Praxis Medical Insights 2, 3
Giving adjuvant therapy, such as diphenhydramine 50 mg IV and ranitidine 50 mg IV, is suggested by Praxis Medical Insights 3
Administering corticosteroids (methylprednisolone 1-2 mg/kg IV) to prevent biphasic reactions is advised by Praxis Medical Insights 3
Monitoring for 24 hours after severe reactions due to the risk of biphasic response is recommended by Praxis Medical Insights 3

Aseptic meningitis is a rare delayed complication presenting with severe headache, neck stiffness, photophobia, and fever, typically occurring 6-48 hours after infusion, according to Praxis Medical Insights 2
Hemolytic anemia can occur, particularly with anti-D immunoglobulin, ranging from mild extravascular hemolysis to severe intravascular hemolysis with disseminated intravascular coagulation, as reported in the journal Blood 4
Mild extravascular hemolysis is common in Rh(D)-positive children receiving anti-D immunoglobulin, according to the journal Blood 4
Rare instances of intravascular hemolysis, DIC, and renal failure have been reported in pediatric patients with comorbidities receiving anti-D immunoglobulin, as noted in the journal Blood 4

The Annals of Oncology suggests considering IV immunoglobulin or plasmapheresis for myasthenia and Guillain-Barré syndrome in patients treated with immune checkpoint inhibitors 5, 6
Withholding checkpoint inhibitors until neurological toxicity is defined is recommended by the Annals of Oncology 5

Monitoring vital signs during and after infusion is advised by Praxis Medical Insights 2, 3
Never delaying epinephrine in suspected anaphylaxis while waiting for antihistamines or corticosteroids is recommended by Praxis Medical Insights 3