[Problems of intravenous gammaglobulin therapy (author's transl)]

The presently available i.v. gammaglobulines (GG) can be classified into two groups. Degraded GG are produced by pepsin or plasmin digestion. Intact GG are obtained by beta-propiolactone treatment, acidification at pH or precipitation with polyethylenglycol-hydroxyethylstarch (PEG/HES). The various products have different characteristics with regard to their biological activity (certain functions of complement activation and opsonization are connected with the Fc structure) as well as their elimination (intact GG have longer intra- and extravasal half-life times). While their is no doubt about an effect of GG in animal experiments, little controlled studies have been done for most of the clinical indications. One controlled prospective study showed that in surgical high risk patients the frequency of septic complications can be reduced by prophylactic application of high doses of 7 S-GG. For the future, the development of a broad spectrum of hyperimmunoglobulines seems desirable.