Intravenous immunoglobulin (
IVIG) is a safe preparation, made of human plasma of thousands of healthy donors. The fascinating history of
gamma globulin therapy begins in 1930 when Finland treated
pneumococcal pneumonia patients with equine serum, which prolonged their survival from
pneumonia. Since then, significant breakthroughs were achieved by Cohn, Bruton, Imbach, and others, whose clinical contribution to the world of medicine was of great importance. Originally
IVIG was used to treat immunodeficiencies. Later on the use of
IVIG extended to
autoimmune diseases as well. The efficacy of
IVIG has been established only in several
autoimmune diseases; clinical reports of trials, series, and case reports indicate significant improvement in many more
autoimmune diseases.
IVIG have also showed antimetastatic effects in a variety of
cancer cell lines, as well as in a few case reports. The efficiency of
IVIG has also been observed in recurrent pregnancy loss (RPL), either as a result of an
autoimmune disease or spontaneous. Several attempts were made to discover the immunomodulatory effects of
IVIG, but it is still not fully understood. Clearly
IVIG has multiple mechanisms of actions, which are thought to cooperate synergistically. One of the main mechanisms of actions of
IVIG is its ability to neutralize pathogenic
autoantibodies via
anti-idiotypic antibodies within
IVIG preparation. The ability of
IVIG to neutralize pathogenic
autoantibodies is of great importance in many
autoimmune diseases, as well as in RPL. In
cancer cell lines,
IVIG modulates the immune system in a few ways, including the induction of
IL-12 secretion, which consequently activates natural killer cells, and the induction of expression of proapoptotic genes only in
cancer cells. Side effects from
IVIG are rare and mostly mild and transient. More importantly adverse effects can be minimized by administration to a selective patient population in a proper way: slow infusion rate of 0.4 g/Kg
body weight IVIG for 5 consecutive days, given in monthly cycles. The only downside of
IVIG therapy is its high price. Therefore, clinicians should balance efficiency versus cost in deciding whether or not to treat certain conditions with
IVIG.