A new strategy for the prevention of IgA anaphylactic transfusion reactions

Management of patients with clinically significant anti-IgA is difficult and unsatisfactory in many aspects.

A 40-year-old man with common variable immunodeficiency had a previous history of anaphylaxis after an intramuscular immunoglobulin administration. His serum contained anti-IgA, and he required immunoglobulins for recurrent infections.

The administration of intravenous immunoglobulins (IVIgG) containing less than 0.1 mg per mL IgA led to an anaphylactic reaction after the transfusion of only 2 to 3 mL. The same IVIgG charge was subsequently pretreated with freshly separated autologous plasma and given to the patient on three consecutive days without any reaction (1.25, 10, and 10 g each in 400 mL plasma). Anti-IgA activity did not increase, and the patient was treated again without complications.

Ex vivo pretreatment of IVIgG preparations with autologous plasma appears to be safe and useful in the management of patients with clinically significant anti-IgA. To achieve a significant IgA blockage, the preparation to be used should not contain large amounts of IgA.

The strategy described here appears to be safe and may help prevent anaphylaxis in many instances.