Treatment - Intravenous Immunoglobulin
Reviewed by: HU Medical Review Board | Last reviewed: November 2022 | Last updated: April 2023
In rare cases, intravenous immunoglobulin (IVIG) may be used as a last option to treat severe chronic hives.1
IVIG is a mix of antibodies made from blood donated by other people. It is used to prevent infections in people with a weak immune system. It may also treat certain autoimmune conditions.1
What is intravenous immunoglobulin?
IVIG is a type of biologic therapy. Biologics are drugs made from living cells. These cells can come from parts of the blood, proteins, viruses, or tissue. The process of making biologics turns these cells into drugs that can prevent, treat, and cure disease. IVIG is made from blood donated by at least 1,000 people.1
IVIG contains a concentrated and diverse mix of antibodies. Antibodies are proteins that help you fight infections. They attach to specific germs to activate your immune system. Your body makes many different antibodies as you get exposed to different germs throughout your life.2
This mix of antibodies can help you fight infections when your immune system is weak. It may also prevent your immune system from fighting your own healthy cells. Conditions that use IVIG include:3
- Chronic pain (neuropathy)
- Hypogammaglobulinemia (immune deficiency where you do not make enough antibodies)
- Immune thrombocytopenia (shortage of blood cells called platelets)
- Some types of leukemia
- Myasthenia gravis
IVIG is an immunomodulator. This means it alters the way the body responds to and makes different cells in the body. It does not suppress or lower the body’s immune response. This is why this type of treatment is often preferred if someone has lowered immunity, such as in cancer or certain autoimmune diseases.
How does intravenous immunoglobulin help treat chronic hives?
IVIG is rarely used to treat chronic hives. Doctors only use it in severe cases when H1 antihistamines and other drugs do not work. Other special situations may also require it. For example, IVIG may be safer than immunosuppressants like cyclosporine in people with a history of cancer.4
IVIG reduces inflammation and the body's immune response. This may reduce symptoms of chronic hives. However, there is not much evidence that IVIG works in people with chronic hives. Doctors also do not know the best dose or treatment schedule for chronic hives. This is why experts do not recommend IVIG for chronic hives except in severe or specific situations.5,6
Examples of intravenous immunoglobulin
There are a few IVIG brands, which differ in how they are made. Some have different mixes of antibodies or additives. Most products are safe for most people. Once you find a brand you tolerate, you should use the same brand every time. Examples of IVIG brands include:7
What are the possible side effects of intravenous immunoglobulin?
Side effects of IVIG vary depending on personal factors, such as your dose and blood type. About 25 percent of people will experience a side effect. These are usually mild and happen after the first dose. Common side effects include:2
- Chills and fever
- Muscle and joint pain
- Nausea and vomiting
More serious side effects are rare but possible. These include:2
- Allergic reactions
- Low blood count (anemia)
- Kidney problems
- Blood vessel blocked by a blood clot (thromboembolism)
Talk to your doctor if you notice any change in symptoms. They may try to reduce your risk of side effects by:2
- Performing blood tests before starting treatment
- Giving the therapy more slowly
- Splitting large doses into multiple smaller doses
- Keeping you hydrated with extra fluids
- Giving pain-relieving drugs
These are not all the possible side effects of IVIG. Talk to your doctor about what to expect with IVIG. You also should call your doctor if you have any changes that concern you about IVIG.
Things to know about intravenous immunoglobulin
IVIG is given into the vein (intravenously). The infusion usually takes 1 to 4 hours. Your dose depends on a number of personal factors, including your weight. IVIG is usually given in a doctor’s office or a hospital setting, such as an infusion center.1
The risk of getting a viral infection from IVIG is very low. IVIG is purified to destroy any bacteria, viruses, and other germs. However, this risk is one reason why IVIG is only given when it is absolutely needed. Hospitals usually need your signed consent and will keep detailed documentation.2
IVIG is very expensive and often not approved by insurance providers. For example, the average cost of IVIG for people with chronic neuropathy is $34,500 per year. It is also inconvenient compared to other therapies for chronic hives. The costs of IVIG usually outweigh the benefits.3,5 Medical insurance coverage and out-of-pocket costs vary.
Tell your doctor your full health history before starting IVIG. Certain medical conditions increase the risk of side effects. Tell your doctor if you: