Immunotherapies

Question 1

IVIG

Answer 1

• IgG immunotherapy.
• Tx of a wide variety of disorders
• autoimmune, deficiency, inflammatory disorders
• Lasts 2 weeks to 3 months

Question 2

IVIG Mechanism

Answer 2

• Protection of the recipient against infection
• Suppression of inflammatory and immune-mediated responses.
• Mech. unknown for autoimmune conditions

Question 3

IgG Routes

Answer 3

• IV, SubQ, IM
• Usually IV
• Usually given in an infusion center

Question 4

IVIG SE, Premedications

Answer 4

• Fever, chills, malaise, HA, dyspnea, urticaria, anaphylaxis(IgA def), thrombosis, hemolysis, kidney injury.
• Premed: Hydrate, APAP, H1 blocker, steroid (pred)

Question 5

Hyperimmune globulin

Answer 5

Similar to IVIG, except prepared form donors with high titers of specific antibodies for specific diseases.
-People with potential exposure are given this.

Question 6

Immune Globulin may decrease the efficacy of ______?

Answer 6

• Live vaccines

- Wait at least 6 months to administer live vaccine.

Question 7

Immune globulins should not be administered to individuals with _____ deficiency.

Answer 7

IgA.

Anaphylaxis may occur

Question 8

Hepatitis B immune globulin (HBIG)

Answer 8

Indications: post exposure prophylaxis to HBV exposure.
-This includes newborns with an HBV+ mother.
Administered IM
Give within 14 days of exposure
Give with HBV vaccine for long lasting immunity

Question 9

HBIG SE, CI

Answer 9

SE: Anaphylaxis, FLS
CI: Allergy to human immune globilin

Question 10

Rabies Immune Globulin

Answer 10

• For post-exposure prophylaxis.
• Inject around wound, then IM into gluteal.
• One-time dose
• Administer vaccine at same time.

Question 11

Tetanus Immune Globulin (TIG)

Answer 11

• Uncertain of hx of tetanus vaccine and open wound.

- Administer IM and with vaccine

Question 12

TIG SE, CI

Answer 12

SE: anaphylaxis, angioedema, nephritic syndrome.
CI: allergy to tetanus toxoid, or IM is contra.

Question 13

Varicella-Zoster Immune Globulin (VariZIG)

Answer 13

• Post-exposure prophylaxis for immunocompromised individual without hx of immunity.
• Generally for post-exposure to chicken pox in individuals who cannot receive a live vaccine (pregnancy).

Question 14

Rh Disease

Answer 14

Happens when Rh- mother has an Rh+ fetus, and only if the father is Rh+.

Question 15

Rho(D) immune globulin (RhoGAM)

Answer 15

IgG anti-D antibodies that suppress the mother’s immune system from attacking Rh+ blood cells from fetal circulation.

Question 16

When is Rhogam given?

Answer 16

• 28 Weeks gestation
• After any trauma to mother, procedures during pregnancy, fetal hemmorhage, abortion.
• Within 72 hours after delivery if baby is Rh+

Question 17

What else is RhoD used for?

Answer 17

Tx of immune thrombocytopenia purpura

Also used for incompatible blood transfusions

Question 18

Allergen Immunotherapy

Answer 18

Desensitization to allergens by down regulating response to antigen.

Question 19

Allergy Immunotherapy indications

Answer 19

• Failure of medical and avoidance therapy.
• Allergen in question causing secondary symptoms.
• Can be used for children with allergic rhinitis, may decrease development of asthma.
• Can be used for venom reactions

Question 20

Allergy Immunotherapy CI

Answer 20

Autoimmune
Pregnancy
HIV
younger than 5yo
must be reliable to follow up.

Question 21

Allergy Immunotherapy Dosing Schedule

Answer 21

Build up Phase:
-1-3 injections/week for several weeks.
Maintenance phase:
-Injections every 2-4 weeks
Duration of therapy:
-3-5 years

Question 22

Hypenoptera (stinging insect)

Answer 22

• Venom immunotherapy is quite effective and well-tolerate.

- Can last 5 years or indefinitely.

Question 23

Anti-IgE therapy

Answer 23

Xolair
Approved for tx of moderate to severe persistent asthma when high-dose inhaled steroids fail.
-May take 12 weeks to see effects
-Long-term