immunological re-evaluation, unless a trial disease or bronchiectasis. An immunoglobulin period of cessation of intravenous washout period of four to six months is immunoglobulin (IVIg) for the purpose of necessary to enable an accurate assessment. immunological evaluation is medically Prophylactic antibiotics may be considered to contraindicated on safety grounds (such as a cover the period of IVIg cessation. patient with neutropenia, on immunosuppressant medication or with Patients may qualify for further IVIg therapy: clinically active bronchiectasis and/or suppurative lung disease*). other immunodeficiency criteria (e.g. common variable Please note*: a diagnosis of bronchiectasis immunodeficiency [CVID]) depending and/or suppurative lung disease must be on the results of subsequent immune consistent with the position statement of the evaluation; or Thoracic Society of Australia and New Zealand and the Australian Lung Foundation (Chang et al rarely under specific antibody 2010). deficiency following re-emergence of severe significant infection requiring hospitalisation. Life-threatening infection or a series of In principle, IVIg should only be continued or significant infections following trial-off Ig therapy renewed if there is a demonstrated clinical in patients with proven specific antibody benefit. deficiency. Note that re-vaccination with pneumococcal Natural history of specific antibody deficiency polysaccharide vaccine is not recommended remains poorly defined, although antibody because of safety concerns, and the potential production will improve for many patients over time, particularly children.
disease or bronchiectasis. An immunoglobulin washout period of four to six months is necessary to enable an accurate assessment. Prophylactic antibiotics may be considered to cover the period of IVIg cessation. Patients may qualify for further IVIg therapy: other immunodeficiency criteria (e.g. common variable immunodeficiency [CVID]) depending on the results of subsequent immune evaluation; or rarely under specific antibody deficiency following re-emergence of severe significant infection requiring hospitalisation. In principle, IVIg should only be continued or renewed if there is a demonstrated clinical benefit. Note that re-vaccination with pneumococcal polysaccharide vaccine is not recommended because of safety concerns, and the potential immunological re-evaluation, unless a trial period of cessation of intravenous immunoglobulin (IVIg) for the purpose of immunological evaluation is medically contraindicated on safety grounds (such as a patient with neutropenia, on immunosuppressant medication or with clinically active bronchiectasis and/or suppurative lung disease*). Please note*: a diagnosis of bronchiectasis and/or suppurative lung disease must be consistent with the position statement of the Thoracic Society of Australia and New Zealand and the Australian Lung Foundation (Chang et al 2010). Life-threatening infection or a series of significant infections following trial-off Ig therapy in patients with proven specific antibody deficiency. Natural history of specific antibody deficiency remains poorly defined, although antibody production will improve for many patients over time, particularly children.
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