While human intravenous immunoglobulin (IVIG) is a valuable therapeutic agent, it necessitates venous access and is sometimes associated with severe side effects including anaphylaxis and aseptic meningitis. An alternative is the subcutaneous (subc) infusion of IG at weekly intervals, usually at a dose of 100 mg/kg for patients with antibody deficiency. Gardulf and associates(Lancet 345:365, 1995) that the subc use of preservative-free IG in Scandinavia is less expensive, more convenient, and better tolerated than monthly IVIG infusions. Since preservative-free 16.5% IG is unavailable in the USA, we have used 10% IVIG subc in 5 antibody deficient patients. The patients, aged 2, 8, 9, 14 and 40 years, had common variable immunodeficiency(CVID) (3), X-linked agammaglobulinemia (1) and Pediatric AIDS (1). One CVID patient had life-threatening anaphylaxis to IVIG, another CVID patient developed aseptic meningitis with her initial IVIG infusion (!) and three had poor venous access. Patients were given 10% Venoglobulin (1), Gamimune N (3) or Gammagard (1). Over 120 weekly infusions for 2 - 13 months have been well tolerated at doses of 100-125 mg/kg/week. These were given over 3-5 hours in the abdomen with a battery operated pump. Trough IgG levels increased from a mean of 160 ±32mg/dl to 430 ±53mg/dl, with an average increase of 370mg/dl. No reactions were noted except for local pain and headache in one patient.

We conclude that weekly Subc IVIG is safer, easier and equally efficacious as IVIG given at monthly intervals. It is particularly well suited for home infusions or conditions where slow continuous release of Ig to the blood is desirable (i.e. protein- losing states, prior aseptic meningitis).