Evidence for the Use of Intravenous Immunoglobulins—A Review of the Literature - ד"ר אוריאל כץ, Shaye Kivity, Uriel Katz, Natalie Daniel, Udi Nussinov

For the treatment of primary immunodeficiencies, in the middle of the 20th century, intravenous immunoglobulins (IVIg) were introduced. These gamma globulins are purified from the pooled plasma of thousands of donors and typically contain more than 95% of unmodified immunoglobulin G (IgG) with only trace amounts of IgA or IgM. They were used for the treatment of autoimmune conditions after patients receiving IVIg for immunodeficiencies showed an improvement in immune-mediated thrombocytopenia. IVIg are considered as an important treatment option in a wide spectrum of diseases like autoimmune and acute inflammatory conditions. IVIg got the approval of US Food and Drug Administration (FDA) for its use against primary immunodeficiencies, Kawasaki disease, immune thrombocytopenic purpura (ITP), chronic B cell lymphocytic leukemia, hematopoietic stem cell transplantation and pediatric HIV. In ITP, IVIg block IgG in Fc-dependent manner and in Kawasaki's disease, they inhibit complexes and components known as C5b-C9 and C3b & C4b. In the case of acquired hemophilia, they act as anti-idiotypes against autoantibodies against factor VIII. IVIg preparations also contains different chemicals called as cytokines and some natural antibodies that act against cells, pathogens, altered molecules, and tumors. Treatment of systemic lupus erythematosus (SLE) patients with IVIg was seen to be a safe and beneficial adjunct therapy in treatment-resistant inviduals with systemic flare-ups. IVIg was useful for the management of bleeding complications in lupus-associated thrombocytopenia carrying patients. IVIg was considered in refractory cases of Subacute cutaneous lupus erythematosus and Systemic vasculitis. The treatment with IVIg was warranted for Churg–Strauss syndrome patients with severe disease or unresponsive individuals. IVIg  acts with interferons to achieve a better response in chronic Hepatitis C virus patients. IVIg treatment was suggested to be effective for systemic and kidney diseases, Systemic sclerosis, severe chronic Juvenile rheumatoid arthritis, myopathies, Acquired hypogammaglobulinemia too and can reduce HIV infections in children. Since cancer is characterized by high inflammation, the use of immunoglobulins for the treatment of cancer might be an interesting approach.