IVIG Therapy Archives - Corinthian Health Services Blog

CIDP IVIG – Treatment of Chronic Inflammatory Demyelinating Polyneuropathy

Jun 20

Are you experiencing tingling in your toes and fingers? How about weakness in the arms and legs? Do you find yourself complaining about extreme fatigue or loss of sensation? These are some of the most common symptoms of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and CIDP IVIG treatment can help.

CIDP is a rare autoimmune and neurological disorder that attacks the nerves. In the United States, about 40,000 people are believed to have the condition, but it is hard to pin down an exact number.

What is CIDP?

Also called chronic relapsing polyneuropathy, the disorder is often caused by damage to the peripheral nerves (the nerves surrounding the outside of the brain) and the spinal cord. CIDP causes the immune system to attack the nerve covering, which is called myelin, causing nerve damage.

Some of the symptoms of the disease include a tingling sensation or numbness that typically starts in the toes and fingers. CIDP patients also experience progressive weakness, fatigue, and loss of sensation.

In the early stages of the disorder, patients usually complain of difficulties in accomplishing minor tasks such as climbing stairs or using a blow dryer. It typically takes about eight weeks for symptoms to develop fully.

Experts consider CIDP to be the chronic form of Guillain-Barre syndrome (GBS). GBS is also an autoimmune disorder that attacks the nerves. The main difference between the two is the speed of progression of symptoms. CIDP develops slowly, while GBS is considered a neurological emergency.

At this point, there is no definitive diagnostic test for CIDP. Medical experts use a combination of patient history, neurological examinations, and other tests such as cerebrospinal fluid (CSF) analysis and complete blood count (CBC). Sometimes, a nerve biopsy is also required.

Risk Factors for CIDP

So far, medical experts haven’t been able to pin down exactly why the disorder strikes some people and not others. Anyone can develop CIDP regardless of age or gender, but it is more common in older adults and tends to affect men more than women. The typical age of onset is 30-60 years old. Having a previous infection also seems to be a risk factor that increases the chances of acquiring the condition.

CIDP IVIG Treatment Plan

If left untreated, CIDP can lead to the progressive loss of strength and sensation. Fortunately, even though the disorder is chronic, it is treatable. In fact, most patients respond very well to treatment. The most important thing is to diagnose the disease as early as possible, which increases the chances of better patient function and overall quality of life.

During treatment, the immediate goal is to control and suppress the symptoms of the disease such as pain, weakness, and sensory loss.

There are several standard treatments known to work for CIDP patients. For the last two decades, intravenous immunoglobulin (IVIG) therapy has been considered the primary treatment option.

Intravenous immunoglobulin (IVIG) is the general term used to refer to replacement therapy. According to a recent study, as much as 50-70% of patients have a positive response to this treatment. In a nutshell, with IVIG, the patient receives injections of antibodies from carefully screened human blood donors. Patients who receive IVIG often show signs of improvement in strength, functional ability and quality of life.

IVIG is proven by medical experts to be safe. It is often given as an outpatient procedure. For most patients, the standard dosage is 2g/kg given intravenously over 2–5 days. The dosage is then usually reduced to by 1g/kg for one day about every three weeks.

With IVIG, improvement can be seen just days after treatment. Some patients may experience side effects such as chills, muscle ache, fever, or rapid heartbeat. In most cases, however, these side effects can be avoided by slowing down the infusion rate.

Other Common CIDP Treatments

Other treatments known to work are plasma exchange therapy and the corticosteroids such as Prednisone.

In plasma exchange therapy, plasma is filtered from the blood and replaced with new fluid. It is often done with a tube or catheter inserted into a vein in the neck. At the start of the treatment, it is typically done five times during a ten-day period. Beneficial effects can last from four to twelve weeks.

Prednisone is a steroid often used to suppress the immune system. It is typically used for diseases such as asthma, Crohn’s disease, allergies, systemic lupus and more. CIDP patients can take Prednisone to help improve muscle strength and coordination, as well as to help strengthen nerve signals. Patients who opt to use Prednisone can expect to see results in five to eight weeks, but intake should continue for at least a year to achieve long-term effects.

If you have questions about CIDP or IVIG treatment for CIDP, you should speak with your doctor.

How Does IVIG Treat Kawasaki Disease

Jun 6

Kawasaki Disease is a rare childhood illness and one of the leading causes of acquired heart disease in infants. The disease is typically IVIG Treat Kawasaki Disease characterized by red rashes on the hands, feet, and body in children under the age of five. If left untreated, it can lead to dangerous heart conditions and, in the worst case scenario, myocardial infarction.

What is Kawasaki Disease?

The immune system attacks blood vessels in children, primarily of Asian descent. Antibodies attack medium-sized blood vessels (including arteries, veins, and capillaries), which leads to acute inflammation and a reduced flow of blood to the heart and valve muscles.

When this happens, the heart may not pump as efficiently, which, in turn, increases the risk of myocardial infarction, arrhythmias, and heart failure. Infants are at risk of aneurysms developing in enlarged blood vessels and clots in narrow ones.

The cause of Kawasaki Disease is unknown, though it’s believed to have a strong genetic component. Untreated symptoms pass through a series of three stages and last around two weeks before the child returns to normal.

Typical symptoms present themselves as a red rash on the hands, feet, and body along with a high fever (above 102.2 F) that lasts for more than five days. Conjunctivitis or red eye, red lips, and a swollen strawberry-colored tongue are typical in the early stages. You may also find swollen lymph nodes in the neck and swelling around the rashes in the hands and feet.

The second phase starts after a few days to a week. Parents often notice the skin peeling in large sheets around the fingers and toes. Vomiting and diarrhea along with abdominal and joint pain are common.

The final phase sees a reduction in the rash, peeling, and swelling and the symptoms slowly dissipate as the child returns to normal. Kawasaki Disease doesn’t usually present itself again and responds well to treatment. However, heart complications may persist if the disease is untreated.

Parents should consult a doctor if they notice a high fever for more than a few days along with the typical rash and strawberry tongue.

Risk Factors

The exact cause of Kawasaki Disease is unknown. Common risk factors appear to be children between the age of one and five of Asian descent, and boys have a slightly higher risk than girls. However, 25% of cases involve infants younger than one and over the age of five. These cases are more likely to present an incomplete set of symptoms which is harder to identify and diagnose correctly.

It’s very likely that Kawasaki Disease has a strong genetic and environmental component. Experts also claim the prevalence varies between different seasons.

Treating Kawasaki Disease with IVIG

Diagnosing and treating Kawasaki Disease as early as possible is imperative to the health of the child. The longer the inflammation continues, the higher the risk of severe damage to blood vessels, heart muscles, and further complications. It is therefore of vital importance to get a correct diagnosis and begin treatment as early as possible. The purpose of treatment is to reduce the inflammation that can cause long-lasting damage to the circulatory system.

Typical treatment is a dose of aspirin and injections of IVIG. Aspirin reduces the risk of blood clots, and IVIG lowers inflammation. The latter are antibodies that are injected into the bloodstream to counter the inflammation, and has a high success rate.

Infants who undergo IVIG treatment typically experience coronary aneurysms in 1-5% of cases compared to 25% or greater in untreated patients.

Children may need to stay in the hospital under close observation by a team of cardiologists to ensure the treatment is reducing the inflammation. Maximum benefits from IVIG happen in the first ten days of manifestation. This is why it is so important for parents to identify symptoms and contact a medical professional as soon as possible.

Severe cases of Kawasaki Disease are extremely rare and are typically associated with no measurable response to the IVIG treatment. In cases like this, doctors will administer a course of corticosteroid therapy. Unfortunately, those who fail to respond to the IVIG are at a much higher risk of heart complications.

The vast majority of children fully recover and have no long-lasting effects after receiving early treatment. Parents should bring their child to be monitored after IVIG to ensure the cardiovascular system hasn’t suffered any irreversible damage.

Things to Remember

Kawasaki Disease usually presents itself in children of Asian descent between the ages of one and five.
The cardinal symptoms are a high fever with rashes on the hands, feet, and body with a swollen
Early diagnosis allows early treatment, which reduces the risk of complications and heart disease.
Proper treatment to reduce the inflammation, if administered in the first ten days, can mitigate the damage caused by Kawasaki Disease in most patients.

IVIG Administration

Apr 11

When you’re undergoing IVIG treatment, it’s important to understand IVIG administration and each step of the process. If you know what to expect ahead of time, it will eliminate a lot of stress and allow things to go as smoothly as possible. Your doctor may follow slightly different procedures, but below are some of the most common situations and suggestions for dealing with them.

Your Responsibilities as a Patient

Before everything else, you should understand your responsibilities before, during, and after the procedure. You are, after all, the one in control. Exactly how the IVIG treatment process proceeds will be dictated by how you feel. As the patient, it will be up to you maintain a close and honest relationship with your doctor and other caregivers.

Your main responsibilities will be to cooperate as best you can, follow their instructions, and maintain an open and honest line of communication. Always let them know if there is anything you need or don’t understand. You should tell them immediately about any problems or issues that arise, especially those that might affect the course of your treatment.

Doctor or Nurse Responsibilities

Above all, safety should be the priority for any doctor or nurse whether they are administering IVIG treatment or educating a patient about infusions. The prescriber’s orders should be followed carefully, with any problems addressed and fully resolved before the infusion.

Assessments Before IVIG Administration

Before beginning the IVIG infusion, your nurse will look at several factors to help minimize any problems, discomfort or adverse effects and make sure you have a successful IVIG infusion experience.

Assess whether the IVIG product is appropriate for the patient. There are different types of IVIG products, which are NOT interchangeable. Your nurse will first check to make sure the present product is suitable for your particular case.
Assess the integrity of the IVIG product. Like any other medication, the nurse will check to make sure that the product is fully intact, no seals have been broken, and it has not been tampered with.
Check that the IVIG product is at the right temperature. The immunoglobulin solution should be at room temperature when it is administered.
Check that the patient understands IVIG therapy. The nurse will check with the patient to make sure they understand the purpose of the therapy and what will be involved in the process.
Check the patient’s general health and hydration level. The nurse should assess whether or not the patient is in a healthy state and properly hydrated. Any problems with health should be communicated to the prescriber. If the patient does not seem to be fully hydrated, this should be remedied before the infusion begins.
Check for any variation in weight. IVIG therapy prescriptions are based on the weight of the patient. Any significant change in weight could mean that the prescription would need to be adjusted.
Check heart rate and respiratory status. IVIG therapy can cause a fluid overload in patients with congestive heart failure. Their heart and respiratory status must be checked before and during infusion to avoid potential problems.
Check the patient for signs of fever. If a patient has a fever, the prescriber should be contacted and consulted for instructions. Depending on condition, the infusion may need to be postponed until the fever subsides.
Assess the need for pre-medications. If a patient has had any issues during previous infusions, the prescriber should be consulted for instructions to see if pre-medications may be necessary to help ensure a successful infusion.
Determine if there is a need for anesthesia. Some patients, especially children, may wish to receive local anesthesia to numb the sites where needles or catheters will be placed.
Assess emergency preparedness. The nurse will make sure that all emergency equipment is functional and nearby as well as make sure there are clear communication channels for reaching both the prescribing doctor as well as emergency services such as 911.
Assess the need for blood work before starting the infusion. Blood must be drawn prior to an IVIG infusion if it is needed for monitoring purposes. The nurse should go over any previous blood work with the patient as well as make sure that regular blood tests are being carried out as expected.
Assess the patient’s experience with prior IVIG infusions. Last, but not least, the nurse should ask the patient about previous experiences and what they expect to happen. Patients, children especially, may have routines they are used to that help them get through the experience with fewer issues. Nurses should try to follow these routines whenever possible.

Assessment During IVIG Administration

During the administration of the IVIG therapy, infusion, the nurse will monitor the patient’s general status and make sure that the infusion is being tolerated. This will involve asking basic questions about how you feel as well as monitoring vital signs for any changes. At this point, as the patient, there isn’t much more to do other than wait for the process to finish.

Assessments After IVIG Administration

After the infusion has been completed, the nurse will generally check on a few things that will allow him or her to assess how well you’ve tolerated the infusion and what could be done to improve your experience during the next one.

Check for problems related to the infusion. The nurse will check for any problems occurring immediately after the infusion that may have been caused by it, such as headaches, fever or rashes. In some cases, changes to the infusion protocols might be suggested to provide some relief in the future.
Assess the need for future infusions and discuss with the patient. The nurse should inform the patient of upcoming IVIG therapy sessions and their responsibility according to what has been ordered by the prescribing doctor.

The Typical IVIG Infusion

IVIG therapy typically consists of a dose between 400 and 500 milligrams per kilogram of weight, given every three to four weeks. The majority of patients tolerate the procedure well and experience little to no adverse effects.

Individual patients may get better results with a more personalized infusion regimen, just as some people respond better to one IVIG product over another. Once you and your doctor have decided on an infusion regimen that works for you, it’s important to stick with it and follow your doctor’s orders. If you have questions about IVIG administration, IVIG therapy, or the IVIG infusion process, you should talk with your doctor.

IVIG Side Effects – Best-Practices to Avoid Them

Mar 14

Adverse drug reactions, commonly referred to as IVIG side effects, are the known, but undesired effects of medications and medical procedures. For example, you might take an analgesic for its intended effect of relieving a headache or sore muscle pain. As a side effect, you might also experience an upset stomach.

Just as with any other type of treatment or medication, there is a possibility of encountering side effects when undergoing IVIG treatment. The good news is that a majority of patients who receive intravenous immunoglobulin therapy don’t experience any side effects at all. It is, however, important for both patient and caregiver(s) to be prepared. If side effects do arise, they are generally easier to control or eliminate if everyone involved plans ahead.

Classification of IVIG Side Effects

IVIG Side Effects

Some side effects of IVIG therapy are more common than others. Overall, side effects are generally categorized as either severe or mild. Severe side effects should be reported immediately to a medical professional and may require extra medical attention. Mild, sometimes called minor, side effects are generally easy to treat and/or control and may even disappear on their own as the body becomes accustomed to the treatment.

Best-practices to Avoid Mild IVIG Side Effects

Mild to moderate side effects of IVIG therapy can often be controlled, or even avoided altogether, with simple, easy to implement treatments. Some of the most common mild side effects include:

Headache
Chills
Myalgia
Increased heart rate/pulse
Nausea
Lower back pain
Hypotension

Headaches and migraines tend to be the most commonly experienced side effects of IVIG. In most cases, patients can control or eliminate these and other side effects through the use of NSAIDS, steroids, and antihistamines before and after an IVIG infusion. In some cases, simply changing IVIG dosage or adjusting the administration schedule can reduce or remove side effects. Additionally, patients have also reported much less discomfort due to side effects when they take steps to make sure they are fully hydrated before, during, and after an infusion.

ivig side effects

Best-practices to Treat Severe IVIG Side Effects

Severe side effects from IVIG therapy are rare. They can often be reduced or avoided by screening patients for factors that would indicate they are predisposed to complications with this type of treatment.

Severe side effects of IVIG therapy can include:

Thrombosis
Acute renal failure
Serum sickness
Stevens-Johnson Syndrome
Aseptic Meningitis
Anaphylaxis

The patient may experience these conditions as labored breathing, difficulty swallowing, severe headache, tightness in the chest, fatigue or weakness, reddening of the skin, or severe itching, especially on the feet and hands.

Treatment for these side effects usually involves administration of antihistamines, steroids, and NSAIDS. In cases of a severe reaction, epinephrine may also be administered. Doctors have had success in eliminating these kinds of side effects for some patients by switching from an intravenous to a subcutaneous IG infusion method.

The Benefits Often Outweigh the Risks

Even though the possibility of experiencing side effects exists, the benefits of IVIG therapy outweigh the risks in the vast majority of cases. If a patient experiences side effects at all, they are usually easily treatable and end up being nothing more than a mild annoyance.

IVIG infusion treatments can provide significant help to patients with an immune deficiency, allowing their bodies to fight off illness and infections that could otherwise be dangerous or even life-threatening.

It has also been shown to be an effective treatment for many autoimmune diseases — when the immune system attacks some part of the body. It has been successfully used as part of the treatment for Chronic Inflammatory Demyelinating Polyneuropathy, Multiple Sclerosis, Multifocal Acquired Sensory and Motor Neuropathy, Dermatomyositis, Polymyositis and others.

ivig side effects - benefits If you think you might be experiencing side effects as a result of your IVIG therapy, during or after an infusion, let your doctor know right away. Together, you’ll be able to decide the best course of action to help you reduce or eliminate any discomfort and get the best possible benefit from your treatment.

IVIG Patient Information – A Comprehensive Guide to IVIG Treatment

Feb 28

Our IVIG patient information article is designed for you and others who may be in your circle of care. Questions about your IVIG treatment plan should be addressed by your doctor. The IVIG patient information provided on our Website, including text, images, audio, video, or other formats are for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

What is IVIG?

IVIG stands for Intravenous immune globulin (“IVIG”). It’s a product made up of antibodies that can be given through a vein. It is prepared from the blood donated by thousands of people, to make a super-concentrated collection of antibodies. Antibodies are proteins that your body makes to help you fight infections.

Over the course of your life, your body makes thousands of different antibodies. Each antibody made by your body is slightly different because it fits like a lock and key to every foreign substance (such as a virus) that gets into your body. This is why you need a new flu shot every year; each year the flu virus is slightly different, and different antibodies (which the vaccine causes your body to produce) are required to protect you.

Why Do I Need IVIG?

IVIG is used primarily in two situations, Primary Immunodeficiency or autoimmune or immune-mediated syndromes. Be sure to ask your doctor if you have specific questions about your treatment plan.

Primary Immunodeficiency occurs when your body does not make enough antibodies. The IVIG simply provides extra antibodies that your body cannot make on its own. The antibodies usually last for several weeks and help your body fight off a large variety of infections.

A second reason you might need IVIG is if your immune system has started attacking your body’s normal cells. These are conditions known as autoimmune or immune-mediated diseases. Some common autoimmune or immune-mediated diseases include multiple sclerosis, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, polymyositis, dermatomyositis, rheumatoid arthritis, and systemic lupus erythematosus.

How is IVIG Given?

IVIG is given into a vein (“intravenously”) in a physician monitored infusion suite. The specific dose ordered by your physician, as well as your tolerance to the medication, will determine your length of stay at the infusion center. Infusion rates are unique to each individual.

The amount of IVIG you need for each dose depends on your weight as well as the reason you are getting the IVIG (your diagnosis). The length of time it takes for an IVIG infusion will vary for each person. On average, it is between 4 to 6 hours. Larger doses are often divided over multiple days for patient tolerability.

Why Do I Have to Have Regular Infusions?

IVIG increases the antibody level within your body. Antibodies, whether those produced naturally by your body or those administered through IV, are eventually metabolized and eliminated by your body within 3-4 weeks. Regular infusions are necessary to maintain immune globulin levels within the desired range.

When Will I Notice the Benefits of IVIG?

Your response will vary depending on your diagnosis (Primary Immunodeficiency or autoimmune or immune-mediated syndromes). Every patient is individual, and your response will be just as individualized. It is important to give the IVIG enough time for your nurses and your physician to evaluate your response

If you are experiencing a Primary Immunodeficiency, your response should be fewer infections, particularly bacterial-type infections. If you continue to get infections while on IVIG you should notify your physician immediately. Your dose may need to be adjusted.

If you are experiencing an autoimmune or immune-mediated disease process, your response is usually determined by the severity of the symptoms you are experiencing, such as pain, mobility, and fatigue. Generally, it will take 3-6 months to fully realize the benefits, but some patients may feel better in a shorter period. Sometimes the benefit that you experience is stability. In other words, your no symptoms don’t get worse.

IVIG Side Effects

IVIG is one of the safest biological products available, and many people do not experience side effects. Some patients may experience mild side effects such as chills, fever, flu-like muscle/joint pain, fatigue, headache, and nausea.

The good news is that almost all side effects can be safely controlled and often eliminated. These side effects are easily managed by doing the following:

Hydrate: It’s critical to properly hydrate beginning 3-5 days before your infusion. Just like combatting the flu, you always want to get plenty of fluids to alleviate side effects. These fluids are increased either orally or in some cases, intravenously before or after your IVIG infusion.
Rate of Infusion: Giving the infusion more slowly; each patient tolerates IVIG infusion rates differently, and your nurses will tailor your infusion to your needs and tolerability.
Smaller Doses: Dividing a large dose into several smaller doses that are given over several days
NSAIDS: Taking NSAIDS like Tylenol, Aleve or Motrin to prevent the fever and flu-like symptoms and taking antihistamines like Benadryl, Claritin or Zyrtec to prevent allergic reactions. Some patients may also take medications like Excedrin Migraine if they have a history of headaches.

What Happens If This Treatment Does Not Work for Me?

All forms of IVIG therapy are effective, but an individual may tolerate one better than another. Many forms of IVIG are available. Talk with your doctor and infusion nurse, and together you can try to find a product or different therapy that works best for you.

Will Insurance Cover My IVIG Infusions?

IVIG Patient Information

Most commercial insurance carriers require prior authorization for IVIG, and medical policies outlining how IVIG is approved. If your doctor partners with Corinthian Health Services, An RN Care Manager will contact you to review your benefits and discuss patient financial responsibility before your infusion. Your RN Care Manager can also recommend patient assistance programs that you may qualify for to help with the out-of-pocket expenses.

What’s Unique About Corinthian Health Services?

Corinthian Health Services requires ALL of our IVIG Infusion Nurses to be nationally board certified in Ig therapy. This distinction is unique among infusion providers and is known as the IgCN certification (Immune globulin Certified Nurse). ivig patient information

Your infusion will occur in a physician-supervised setting, within the physician’s office. This ensures the highest level of safety and care in the industry.

Our infusion centers are designed to be a place of relaxation as well as a center of clinical excellence! Corinthian believes that optimal health and the very best infusion experience is realized in a safe and spa-like setting. Corinthian provides healthy snacks and drinks to enjoy during your infusion.

Your infusion experience is also tailored to YOUR needs, whether you need to work on your computer or watch television or just take a nap. We discourage the use of cell phone conversations within the infusion center to provide privacy as well as respecting the relaxing atmosphere we strive to maintain. We do provide areas outside the infusion center where cell phone usage is allowed.

IVIG Patient Information

If your physician has partnered with Corinthian Health Services, your referral is sent to your local Corinthian Infusion Suite. Once the Care Manager has received your paperwork, they will contact you to let you know the approximate time to receive authorization from your insurance carrier (days to weeks depending on insurance provider).

When the Care Manager receives authorization for your IVIG therapy, they will contact you to provide IVIG patient information, discuss benefits, and financial responsibility. Next, you will receive a call from the Corinthian clinical team for scheduling and instruction on how to prepare for your IVIG infusion appointment.

If your physician has not partnered with Corinthian Health Services, your experience will be different. Speak to your physician about your desire to use our services, and he or she may be able to direct you to a local Corinthian Infusion Suite.