[Rational for the use of human immunoglobulins in clinical practice]

The Clinic for Rheumatology and Clinical Immunology of the Military Medical Academy, with the participation of the hosts and experts from eminent Yugoslav institutions, in April 1997 organized the symposium on two current and trendy subjects from clinical immunology: "Antiphospholipid syndrome" and "The use of polyvalent intravenous immunoglobulins in the clinical praxis". This paper summarizes the contemporary knowledge about the structure and biological activity of immunoglobulins, methods for their production, different pharmacokinetic and pharmacodynamic characteristics of two types (5S and 7S) IVIG preparations, etc. We pointed out three basic groups of indications for IVIG clinical use: 1) substitutional therapy in the primary and secondary immunodeficiencies; 2) adjuvant therapy for severe infections; 3) immunomodulation in autoimmune diseases. Particular emphasis was put on currently known mechanisms of immunosuppressive action of IVIG in autoimmune diseases. Except for presently accepted indications for their use (idiopathic thrombocytopenic purpura and Kawasaki syndrome) we mentioned about 40 different diseases in hematology, neurology, rheumatology and other branches of medicine, from neonatology to transplantology, in which IVIG had shown some efficacy. Possibilities of different therapeutic modalities and the choice of diverse pharmacokinetic and pharmacodynamic effects, benefit the very wide spectrum of diseases, while minimal incidence of adverse effects suggested them to be the therapy of the future in the clinical practice.