Conditions for which IVIg use is not supported

This chapter comprises conditions for which the use of intravenous immunoglobulin (IVIg) therapy is not supported at this time, because there is evidence of no benefit, insufficient evidence of benefit, or some evidence of benefit but preferred alternative therapies are available.

Table 8 Conditions for which IVIg use is not supported

Conditions for which IVIg use is not supported
Condition	Level of evidence
Acute optic neuritis IVIg is not supported in this setting. There is anecdotal evidence for use in Devic disease but not optic neuritis. Reference Roed, HG, Langkilde, A, Sellebjerg, F, et al 2005, ‘A double- blind randomised trial of intravenous immunoglobulin treatment in acute optic neuritis’, Neurology, vol. 64, pp. 804–10.	2b
Acute rheumatic fever	2b
Adrenoleukodystrophy	4b
Amegakaryocytic thrombocytopenia	4b
Antiphospholipid syndrome (non-obstetric)	4b
Aplastic anaemia/pancytopenia	4b
Asthma	2c
Atopic dermatitis/eczema — adult	2b
Autism	4b
Autologous haemopoietic stem cell transplantation Use of IVIg in autologous stem cell transplant recipients is not supported unless the patient has established humoral deficiency (see Secondary hypogammaglobulinaemia).	2c
Behçet’s disease	4b
Cardiac surgery with bypass — prophylaxis IVIg is not supported in this setting; preferable alternative treatments are available.	2a
Congestive cardiac failure IVIg is not supported in this setting; preferable alternative treatments are available.	2a
Crohn’s disease	4b
Diamond Blackfan syndrome	4b
Female infertility	4a
Glomerulonephritis — IgA nephritis	2b
Haemolytic uraemic syndrome	4b
Henoch–Schonlein purpura	4b
HIV/AIDS — adult (see Secondary hypogammaglobulinaemia and/or ITP in adults)	2b
Idiopathic dilated cardiomyopathy	2b
Linear IgA disease	4b
Lupus cerebritis IVIg is not supported as preferable alternative treatments are available.	4a
Lupus nephritis IVIg is not supported in this setting; preferable alternative treatments are available.	2a
Motor neuron disease/amyotrophic lateral sclerosis Note: IVIg is sometimes used when the diagnosis of motor neuron disease has not yet been established and an alternative diagnosis of multifocal motor neuropathy has not been ruled out.	4b
Myalgic encephalomyelitis	2c
Narcolepsy/cataplexy	4a
Nephrotic syndrome IVIg is not supported in this setting; preferable alternative treatments are available.	2a
Obsessive compulsive disorders IVIg is not supported in this setting (see PANDAS).	4a
Polyneuropathy of critical illness	4a
Recurrent foetal loss (with or without antiphospholipid syndrome) Reference Empson, M, Lassere, M, Craig, J, et al 2005, ‘Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant (Cochrane Review)’, in The Cochrane Library, Issue 2, John Wiley & Sons, Ltd, Chichester, UK.	3
Rheumatoid arthritis IVIg is not supported in this setting; preferable alternative treatments are available.	2c
Sepsis Adult and paediatric treatment or prevention If IgG levels are low, the use of IVIg should be considered under PID and/or secondary hypogammaglobulinaemia (including iatrogenic immunodeficiency). Neonatal prevention IVIg is not supported. Therapy with intravenous immune globulin had no effect on the outcomes of suspected or proven neonatal sepsis (Brockelhurst et al 2011). References Alejandria Marissa, M, Lansang, M-AD, Dans Leonila, F & Mantaring, III JB 2002, ‘Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock’, Cochrane Database of Systematic Reviews, vol. 1, doi:10.1002/14651858. CD001090. Brockelhurst, et al 2011, ‘International Neonatal Immunotherapy Study (INIS) collaborative group. Treatment of neonatal sepsis with intravenous immune globulin’, New England Journal of Medicine, vol. 365, pp. 1201–11. Kreymann, KG, de Heer, G, Nierhaus, A & Kluge, S 2007, ‘Use of polyclonal immunoglobulins as adjunctive therapy for sepsis or septic shock’, Critical Care Medicine, vol. 35, no. 12, pp. 2677–85. Ohlsson, A & Lacy, J 2010, ‘Intravenous immunoglobulin for suspected or subsequently proven infection in neonates’, Cochrane Database of Systematic Reviews, doi:3CD001239. Orange, JS, Hossny, EM, Weiler, CR, et al 2006, ‘Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology’, Journal of Allergy and Clinical Immunology, vol. 117, no. 4, pp. S525–53.	2a
Sickle cell disease	4b
Systemic lupus erythematosus (SLE) IVIg is not supported in this setting; preferable alternative treatments are available.	2a
Ulcerative colitis	4b