Sub-cutaneous immunoglobulin

Many children with primary immunodeficiency require regular replacement therapy with immunoglobulin (IgG). Immunoglobulin is produced from plasma (blood donations). Immunoglobulin will give your child protection with antibodies against common infections in the UK.

This treatment can be given intravenously (through a tube directly into the bloodstream) but it may also be given by rapid subcutaneous infusions under the skin. Subcutaneous treatment has been used extensively for some years and is now widely used in specialist centres in the UK. It is ideal for younger children whose veins are difficult to find and who require relatively small doses. It is safe and easy to administer and therefore ideal for home therapy which we would like to support your child to be able to have at home.

Immunoglobulin products and safety

As with all blood products there is a small risk of transmitting infections but all products are carefully monitored to minimise this risk. The benefits of the treatment in preventing life threatening infections outweigh these risks.

As subcutaneous treatment is becoming more popular, several companies who manufacture intravenous immunoglobulin are now manufacturing products for subcutaneous use. These products are made to the same strict specifications, with specific virus inactivation processes, as the intravenous products.

The infusions are extremely well tolerated and give good IgG replacement levels with a lower incidence of adverse reactions than with intravenous preparations. Subcutaneous therapy may also give more natural IgG levels as smaller doses are given more frequently, thus avoiding the initial high levels given with 3 or 4 weekly intravenous infusions.

How is the immunoglobulin given?

The subcutaneous immunoglobulin is a more concentrated solution than the intravenous preparations so that smaller volumes are given.

Infusions are given through a single, double, triple or quadruple sited needle simultaneously through fine needles under the skin on the
abdomen or thighs. The infusions are given using small portable infusion pumps (usually Freedom 60 or Freedom Edge) and take 30 to 60 minutes. Most children can tolerate 10mls per site although 5mls or 7.5mls may be given to very young children. This dose will be different for each individual based on how they tolerate the treatment. Some older children may prefer to do this manually using a slow push route. Other equipment needed for the infusions is syringes, needles, butterfly needles and tape.

How often is the immunoglobulin given?

The dose of immunoglobulin is the same as for intravenous treatment but given generally weekly or fortnightly. The dose may change over time depending on your child’s blood levels and weight.

How is the treatment monitored?

To make sure that the dose is correct, regular blood tests are taken for immunoglobulin levels. Blood is also taken for liver function and full blood count tests to detect early signs of infection. These can be taken from a finger prick or from a vein at Sheffield Children’s Hospital. Bloods tests are usually taken every 3 months. It is really important to have these blood test done so that the doctor and nurse can monitor your treatment.

Home therapy

Home therapy has proved to work well and have many benefits to children and families. These include saving time missed from work and school, reducing time spent travelling to and from hospital and by giving greater freedom and autonomy to families. Home infusions also minimise the stress associated with repeated hospital visits.

Training

The aim of home therapy is to make each family as independent as possible and we will provide training in all aspects of subcutaneous immunoglobulin infusions, including possible adverse effects. Training for home therapy can be started once your child is stable on treatment.

Written instructions and a training record are given to each family. The local community team may be invited to attend with your family if you are unfamiliar with the treatment.

Each family are expected to keep written records of the home infusions, and these records are returned to us. We will continue to monitor your child in out-patients.

Adverse reactions

Adverse reactions occur more frequently during the first few infusions, but they may occur at any time. The most common cause of adverse reactions in a stable child is infection, so immunoglobulin should not be given when your child has an infection. If your child is unwell, the infection should be treated with antibiotics first and the immunoglobulin given once the temperature has settled and the infection is under control.

Most reactions are mild and if a reaction does occur the infusion should be stopped and antihistamine given. Please contact us if you are worried.

Community support

If you live out of the Sheffield area the community nurses can support immunoglobulin being given at home. The doctor at Sheffield Childrens Hospital prescribes the treatment although it will be delivered to you through a home delivery service.