Anaphylactoid reaction to human gamma globulin. Report of a case and inquiry into mechanism

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Abstract
A patient is reported who suffered an anaphylactoid reaction to the intramuscular administration of human gamma globulin (HGG). A portion of the sample he received contained aggregated IgG which is "biologically active" and can be expected in varying amounts in all commercial HGG. There was no evidence of allergy to HGG with skin testing, genetic factor studies, or subsequent administration. It is most likely that our patient inadvertently received a portion of the administered HGG intravenously, or that he rapidly absorbed a large depot of intramuscular HGG. Because he had hypo-gammaglobulinemia, the aggregated HGG was particularly active in vivo and resulted In an anaphylactoid reaction. There is no evidence that an antigen-antibody reaction was involved. For safe use of HGG in patients with an antibody deficiency syndrome care should be taken to avoid intravenous administration, and it should be administered intramuscularly In divided, small, interrupted doses. In our patient this has been safely administered in 2.5-ml injections, not exceeding 8 injections at one round. It is not necessary to avoid future use of HGG in many patients who have had an adverse reaction to it; cautious use may enable the patient to benefit from the continued administration of this valuable agent. What ill effects the long-term administration of HGG aggregates might have is unknown.