Expanding the Mosaic Functions of Intravenous Immunoglobulin

Authors: Danieli, MG; Shoenfeld, Y

Affiliations: Postgraduate School of Allergy and Clinical Immunology, Università Politecnica delle Marche, Torrette di Ancona, Italy; Reichman University, Herzelia.

Publication: Israel Journal of Allergy and Clinical Immunology; 2025; 156. 327–329

ABSTRACT: Intravenous immunoglobulin (IVIG) is a pooled polyclonal medical preparation of IgG derived from the blood of human donors and used in the first instance to treat humoral immunodeficiencies. Since the initial report on the impressive effects of high doses of IVIG in idiopathic thrombocytopenic purpura, IVIG has been used successfully for an increasing spectrum of autoimmune and inflammatory conditions. Currently, high dose IVIG has been approved for the treatment of immune thrombocytopenia, Guillain-Barre syndrome, Kawasaki disease, chronic inflammatory demyelinating polyradiculoneuropathy, multifocal motor neuropathy, and dermatomyositis. Additionally, off-label indications of IVIG include other immune mediated neurologic, hematologic, and dermatologic diseases and even coronavirus disease 2019 (COVID-19)-induced autoimmune diseases. Regarding the latter issue, the discovery of several autoantibodies, including those directed against G protein–coupled receptors belonging to the superfamily of human integral membrane proteins, has confirmed the role of the coronavirus in the emergence of autoimmune conditions. Several hypotheses have been proposed over the years to explain how IVIG can be beneficial in diseases with diverse etiopathogenesis affecting different organ systems.