From Immune Substitution to Immuno-modulation

Abstract

Intravenous immunoglobulins (IVIG) are currently used in many fields of medicine for replacement and immunomodulation. This review focusses on the milestones in the history of human immunoglobulins since the initial observation by Ogden C. Bruton who described replacement therapy in a single boy with agammaglobulinemia. Since then, the preparations used for treatment have been markedly improved with respect to tolerability, clinical efficacy, and pathogen safety. Preparations and appropriate pumps for sc administration of IgG have been developed offering an alternative mode of treatment for immunodeficient patients. Appropriate replacement today allows patients with humoral immunodeficiencies to reach adulthood and normal or near-normal quality of life. In 1981, a second fundamental discovery was made. Paul Imbach and coauthors in children with ITP, a well-defined autoimmune disease, showed that IVIG has immunomodulatory potential offering a chance for affected children to receive effective treatment with little or no side effects compared to systemic steroids. This new principle of treatment encouraged many researchers worldwide to exploit the potential of IVIG in many other immunopathological situations too. As an example for an alloimmune disease, rhesus hemolytic disease in newborn babies is discussed. Finally, Kawasaki disease (syndrome) as an example for a disease associated with massive inflammation highlights broadness of IgG’s therapeutic potential.