| In the 1940s Cohn and colleagues developed a relatively straightforward chemical process for fractionating human blood into many of its significant component proteins, thus enabling the production of the first immunoglobulin concentrates (although suitable for intramuscular use only). In the following decade, Bruton and others recognized the genetic basis of various types of primary immunodeficiency syndromes and further characterized them. These two discoveries allowed for the regular treatment of patients using replacement infusions of human immunoglobulins and the concomitant improvement in quality of life and, ultimately, survival. Subsequently, specific immunoglobulin preparations were produced for treatment of or prophylaxis against specific pathogens such as hepatitis B, polio, tetanus, and pertussis. All of these so-called hyperimmune globulins were administered by the intramuscular route. |
| It became quite clear that this means of administration was not adequate for both the provider and the patient. Injections were quite painful; doses were limited in size and frequency; muscle proteases degraded much of the infused immune globulins; and the remaining protein reached the circulation only after significant delay. Attempts to inject material directly into the vasculature proved to be dangerous, and occasionally catastrophic, apparently as a result of the IgG aggregates that formed as part of the fractionation process. Subsequent developments employing first partial enzyme digestion (using proteases such as pepsin and papain) and then improvements in the fractionation process allowed for the ultimate production of true intravenous immunoglobulin (IVIG) concentrates. |
| Since the late 1970s when these concentrates became widely available, their use has grown exponentially. The serendipitous discovery by Imbach, Barandun, and colleagues in 1980 that IVIG could reverse the autoimmune thrombocytopenia in a young patient with severe chronic ITP and secondary hypogammaglobulinemia opened another avenue of applications: the treatment of autoimmune diseases. |
| Our goal in compiling this volume was to summarize critically the large array of clinical literature available on the use of IVIG preparations. Indeed, a review of MEDLINE citations since 1980 showed more than 1800 entries. Much of the work over the past several years has involved controlled clinical trials, putting research in this area on a firm, scientific footing. This is the focus of our book. |
| In recent years, studies have shown that IVIG may be useful in treating various primary and secondary immunodeficiencies. With regard to the latter, successful trials have been conducted in AIDS patients, premature neonates, individuals with multiple myeloma and chronic lymphocytic leukemia, bone marrow and liver transplantees, patients after high-risk (for infection) abdominal surgeries, and thermal burn victims. |
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