Dr. N. Ashok Viswanath
Infectious Diseases
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have been suffering from immune deficiency. Can you please help me to understand the use of immunoglobulin in conditions such as immune deficiency, usually various doses of IVIG would be infused or even self-administered Sub-Q depending on the indication, but in what cases or conditions would "Bharglob" be utilized? It seems tempting to presume Bharglob 1 mL or 2 mL could be substituted for IVIG using a series of smaller injections over time. I would be grateful for your opinion on it. Many thanks.
Hi,
Welcome to icliniq.com.
I understand your query.
We actually use immunoglobulins for two purposes. One purpose is when immunity is low, we use it to protect ourselves from infections. Another purpose is for autoimmune disorders, where we use immunoglobulins to decrease autoimmunity. There are various formulations available for various routes of administration. Bharglob is an intramuscular injection preparation. Whenever an intravenous immunoglobulin is administered, it causes a rapid increase in serum immunoglobulin level, and the rapid spiking does not happen with intramuscular and subcutaneous preparation. Systemic adverse reactions are more common with intravenous immunoglobulin compared to intramuscular and subcutaneous preparations. The selection of preparation depends on the patient's condition, patient compliance, prior allergic history, and affordability of the patient.
I hope my answer clarifies your doubt.
Regards.
Patient's Query
Hello doctor,
Thank you for your valued response. The obvious question is with dosing. IVIG is significantly higher than a relatively low dose IM Bharglob or Intaglob injection and is taken up immediately (systemic adverse reaction is understandable), but are they really comparable therapeutically? Along with the factors you have quite rightly asserted, that would depend on the type and severity of the condition being treated, I would imagine. From what I can gather, for example, primary immune deficiency, acute neurological conditions, such as CIPD, or severe autoimmune situations such as that with lupus might require 50 to 200 % (gram IgG/kg) immunoglobulin dosing using IVIG or SubQ IG. Whereas in relatively milder conditions, such as mild neutropenia with recurrent infection, psoriasis, a milder autoimmune stage, autoimmune neuropathy, or herpetic neuralgia, etc the list goes on. My understanding is that exogenous immunoglobulin use would not be warranted. Can you help me to understand why? Would there be any merit in using Bharglob 16.5 % in these circumstances or even a low dose like 0.5 % in 10 mL? At these doses, how might autoantibodies be affected? Or chronic infections?
Hello,
Welcome back to icliniq.com.
I understand your query.
Yes, the dose depends on the type of condition and its severity. It also depends on the availability of immunoglobulin. The therapeutic efficacy is actually based on various proven human pharmacology research studies. Exogenous use of immunoglobulin has really good efficacy and has also been demonstrated to be a good treatment for certain conditions. It actually depends on the concentration and patient tolerance too. Certain conditions warrant higher dose, while certain condition needs lower dose. It actually acts against autoantibodies by suppressing the proliferation of particular immune cells, which produce antibodies known as B lymphocytes and modulate antibody production.
I hope my answer clarifies your doubt.
Take care.
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Infectious Diseases
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