Successful Immunoglobulin Desensitization after Anaphylactic Shock in a Patient with Chronic Inflammatory Demyelinating Polyneuropathy (P02.229)

Objective: A case report of a successful desensitization protocol in a patient with immunoglobulin induced severe anaphylactic reaction. Background Intravenous Immunoglobulin (IVIG) is an accepted mainstay of treatment in patients with progressive chronic inflammatory demyelinating polyneuropathy (CIDP). Anaphylactic reactions to IVIG therapy are relatively rare, and usually related to low immunoglobulin A (IgA) levels. Though a successful desensitization protocol for anaphylactic reactions is well known, to our knowledge successful application in a patient receiving IVIG without immunoglobulin deficiency has not previously been reported. Design/Methods: Case report from a tertiary medical center. Results: We present a 69 year old male treated with IVIG for progressive CIDP who experienced an anaphylactic reaction during the IVIG test dose. Serum IgA level prior to test dose was normal. After failing alternate treatments and continued symptomatic progression, we rechallenged the patient with IVIG after desensitization under supervision in the neurological intensive care unit. The patient was premedicated with prednisone; and his required IVIG dose was calculated according to body weight. Desensitized protocol consisted of an initial IVIG dose of 1/10,000 of the required total dose with subsequent doubling of the dose every 30 minutes over a 24 hour period. The desensitization was well tolerated up to the completion of the IVIG dose without significant complication. Subsequently, the patient was able to tolerate multiple sessions of IVIG with symptomatic improvement of his CIDP. Conclusions: To our knowledge this is the first reported case of IVIG desensitization for an anaphylactic reaction in a patient with continued progression of CIDP refractory to alternate treatment modalities. Disclosure: Dr. Malaiyandi has nothing to disclose. Dr. Gupta has nothing to disclose. Dr. Pandya has nothing to disclose. Dr. Barboi has nothing to disclose.