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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Immune Globulin - Drugs and Lactation Database (LactMed®) - NCBI Bookshelf</title>
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<meta name="citation_inbook_title" content="Drugs and Lactation Database (LactMed®) [Internet]">
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<meta name="citation_title" content="Immune Globulin">
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<meta name="citation_publisher" content="National Institute of Child Health and Human Development">
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<meta name="citation_date" content="2024/10/15">
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<meta name="citation_pmid" content="30000497">
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<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK501437/">
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<meta name="citation_keywords" content="Gammaglobulin">
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<meta name="citation_keywords" content="Immunoglobulin">
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<meta name="citation_keywords" content="Sandoglobulin">
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<meta name="citation_keywords" content="Vivaglobin">
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<meta name="citation_keywords" content="Carimune">
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<meta name="citation_keywords" content="Gamunex">
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<meta name="citation_keywords" content="gamma-Globulins">
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<meta name="citation_keywords" content="Immune globulin">
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<meta name="citation_keywords" content="Gamma globulin">
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<meta name="citation_keywords" content="gamma-Globulin">
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<meta name="citation_keywords" content="Gamimune N">
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<meta name="citation_keywords" content="Globulin, immune">
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<meta name="citation_keywords" content="Immune endoglobulin">
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<meta name="citation_keywords" content="Globulins, gamma-">
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<meta name="citation_keywords" content="IVIG">
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<meta name="citation_keywords" content="Human immune globulin g">
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<meta name="citation_keywords" content="Globulin, Immune [USP]">
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<meta name="citation_keywords" content="EINECS 232-706-1">
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<meta name="citation_keywords" content="Cutaquig">
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<meta name="DC.Title" content="Immune Globulin">
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<meta name="DC.Date" content="2024/10/15">
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<meta name="description" content="Immune globulin G (IgG) is a normal component of breastmilk. Data from 2 mothers indicate that IgG concentrations in milk are normal or higher and IgM levels in milk are normal or lower during intravenous immunoglobulin (IVIG) therapy. The antibacterial activity of milk in these women was normal. There appears to be an emerging consensus that intravenous immune globulin is the treatment of choice for postpartum mothers with multiple sclerosis who are breastfeeding,[1-4] although one retrospective study failed to find a decrease in relapse rate among mothers who received IgG postpartum.[5] Rare cases of transient rash have been reported in breastfed infants during maternal IVIG therapy. No special precautions are required during breastfeeding.">
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<meta name="og:title" content="Immune Globulin">
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<meta name="og:description" content="Immune globulin G (IgG) is a normal component of breastmilk. Data from 2 mothers indicate that IgG concentrations in milk are normal or higher and IgM levels in milk are normal or lower during intravenous immunoglobulin (IVIG) therapy. The antibacterial activity of milk in these women was normal. There appears to be an emerging consensus that intravenous immune globulin is the treatment of choice for postpartum mothers with multiple sclerosis who are breastfeeding,[1-4] although one retrospective study failed to find a decrease in relapse rate among mothers who received IgG postpartum.[5] Rare cases of transient rash have been reported in breastfed infants during maternal IVIG therapy. No special precautions are required during breastfeeding.">
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class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK501437_"><span class="title" itemprop="name">Immune Globulin</span></h1><p class="fm-aai"><a href="#_NBK501437_pubdet_">Publication Details</a></p><p><em>Estimated reading time: 4 minutes</em></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><p>CASRN: 9007-83-4</p><div id="LM555.Drug_Levels_and_Effects"><h2 id="_LM555_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM555.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Immune globulin G (IgG) is a normal component of breastmilk. Data from 2 mothers indicate that IgG concentrations in milk are normal or higher and IgM levels in milk are normal or lower during intravenous immunoglobulin (IVIG) therapy. The antibacterial activity of milk in these women was normal. There appears to be an emerging consensus that intravenous immune globulin is the treatment of choice for postpartum mothers with multiple sclerosis who are breastfeeding,[<a class="bibr" href="#LM555.REF.1" rid="LM555.REF.1">1</a>-<a class="bibr" href="#LM555.REF.4" rid="LM555.REF.4">4</a>] although one retrospective study failed to find a decrease in relapse rate among mothers who received IgG postpartum.[<a class="bibr" href="#LM555.REF.5" rid="LM555.REF.5">5</a>] Rare cases of transient rash have been reported in breastfed infants during maternal IVIG therapy. No special precautions are required during breastfeeding.</p></div><div id="LM555.Drug_Levels"><h3>Drug Levels</h3><p><i>Maternal Levels.</i> Colostrum (3 days postpartum) and milk (7 days postpartum) samples from 2 mothers who were receiving IVIG for the treatment of common variable immunodeficiency were studied. One mother was receiving 400 to 500 mg/kg of IVIG monthly and the other received 600 to 700 mg/kg of IVIG monthly. The time of the last dose before sample collection was not reported. IgG concentrations were normal in the first mother's colostrum and milk and higher than normal in the colostrum of the second mother. IgM levels were normal in the colostrum and milk first mother and low in the second. The colostrum and milk of both mothers strongly inhibited adhesion of enteropathogenic <i>Escherichia coli in vitro.</i>[<a class="bibr" href="#LM555.REF.6" rid="LM555.REF.6">6</a>]</p><p><i>Infant Levels.</i> Relevant published information was not found as of the revision date.</p></div><div id="LM555.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>In a retrospective study of 108 women with relapsing-remitting multiple sclerosis, 69 received IVIG postpartum. Those who received IVIG received either 0.4 g/kg daily for 5 days plus additional doses of 0.4 g/kg at 6 and 12 weeks postpartum (n = 41), or IVIG 0.4 g/kg daily for 5 days during the first 6 to 8 weeks of pregnancy, then 0.4 g/kg every 6 weeks until 12 weeks postpartum. Seventy-three percent of the 108 infants were breastfed until 3 to 12 weeks postpartum. No serious adverse event occurred in any of the infants and the mothers who breastfed had outcomes as good as those who did not.[<a class="bibr" href="#LM555.REF.7" rid="LM555.REF.7">7</a>]</p><p>A case series reported 43 women with multiple sclerosis who received 60 grams of IVIG within 3 days of delivery and 10 grams monthly. All of the women breastfed their infants for at least 4 weeks. The only adverse effect reported in infants was a transient rash one day after a maternal dose of IVIG which was possibly caused by the IVIG. The relapse rate was lower than with historical controls who did not receive IVIG.[<a class="bibr" href="#LM555.REF.8" rid="LM555.REF.8">8</a>]</p><p>A European double-blind, randomized trial compared two IVIG regimens in 168 postpartum mothers with multiple sclerosis to observe the relapse rate. One group received 150 mg/kg within 24 hours of delivery and monthly for 6 months. The other group received 450 mg/kg within 24 hours of delivery, 300 mg/kg on day 2 and 150 mg/kg on day 3 postpartum followed by monthly doses of 150 mg/kg until 6 months postpartum. More mothers who breastfed for 3 months or longer were relapse free during the study than those who did not breastfed or who breastfed less than 3 months. In all, 91 mothers breastfed for 3 months or longer and 48 mothers breastfed for less than 3 months. No mention was made of adverse effects in breastfed infants.[<a class="bibr" href="#LM555.REF.9" rid="LM555.REF.9">9</a>]</p><p>A woman with pemphigoid gestationis was treated with several courses of intravenous immune globulin 2 grams/kg over 3 days during pregnancy as well as at 4, 9 and 13 weeks postpartum. She was also receiving prednisolone in a dosage tapering from 0.7 mg/kg daily to 1 mg daily. She breastfed her infant (extent not stated) for 3 months with no problems noted.[<a class="bibr" href="#LM555.REF.10" rid="LM555.REF.10">10</a>]</p><p>In a study comparing the timing of IVIG on the relapse of relapsing-remitting multiple sclerosis, 24 patients were treated with IVIG starting in the first 24 hours after delivery and during lactation. The authors concluded that IVIG is effective in reducing the frequency of postpartum-related relapses. No adverse effects were noted. Further details were not provided in the published abstract.[<a class="bibr" href="#LM555.REF.11" rid="LM555.REF.11">11</a>]</p><p>A mother with pemphigus vulgaris received three cycles of IVIG 120 grams intravenously for 5 days during pregnancy along with daily prednisolone 30 mg orally. She gave birth to a normal, healthy infant with no skin lesions and breastfed her infant (extent not stated). About 21 days after delivery, she began her fourth cycle of IVIG. On the second day of IVIG therapy, the neonate developed an erythematous, purpuric macular rash all over the body with no clinical or laboratory indication of systemic infection. The rash resolved within a few days without any intervention.[<a class="bibr" href="#LM555.REF.12" rid="LM555.REF.12">12</a>] The rash was possibly caused by IVIG.</p></div><div id="LM555.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>Relevant published information was not found as of the revision date.</p></div><div id="LM555.Alternate_Drugs_to_Consider"><h3>Alternate Drugs to Consider</h3><p>(Multiple Sclerosis) <a href="/books/n/lactmed/LM306/?report=reader">Glatiramer</a>, <a href="/books/n/lactmed/LM307/?report=reader">Interferon Beta</a>, <a href="/books/n/lactmed/LM180/?report=reader">Methylprednisolone</a></p></div><div id="LM555.References"><h3>References</h3><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="LM555.REF.1">Dudesek
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A, Zettl
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UK. Intravenous immunoglobulins as therapeutic option in the treatment of multiple sclerosis.
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J Neurol
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2006;253 (Suppl 5):V50-8.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/16998754" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16998754</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="LM555.REF.2">Ferrero
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S, Pretta
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S, Ragni
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N.
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Multiple sclerosis: Management issues during pregnancy.
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Eur J Obstet Gynecol Reprod Biol
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2004;115:3-9.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/15223156" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15223156</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="LM555.REF.3">Ringel
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I, Zettl
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UK. Intravenous immunoglobulin therapy in neurological diseases during pregnancy.
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J Neurol
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2006;253 (Suppl 5):V70-4.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/16998758" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16998758</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="LM555.REF.4">Götestam Skorpen
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C, Hoeltzenbein
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M, Tincani
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A, et al.
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The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation.
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Ann Rheum Dis
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2016;75:795-810.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/26888948" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26888948</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="LM555.REF.5">Fragoso
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YD, Adoni
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T, Alves-Leon
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SV, et al.
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Postpartum treatment with immunoglobulin does not prevent relapses of multiple sclerosis in the mother.
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Health Care Women Int
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2015;36:1072-80.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/25187102" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25187102</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="LM555.REF.6">Palmeira
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P, Costa-Carvalho
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BT, Arslanian
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C, et al.
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Transfer of antibodies across the placenta and in breast milk from mothers on intravenous immunoglobulin.
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Pediatr Allergy Immunol
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2009;20:528-35.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/19220771" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19220771</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="LM555.REF.7">Achiron
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A, Kishner
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I, Dolev
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M, et al.
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Effect of intravenous immunoglobulin treatment on pregnancy and postpartum-related relapses in multiple sclerosis.
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J Neurol
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2004;251:1133-7.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/15372259" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15372259</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="LM555.REF.8">Haas
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J.
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High dose IVIG in the post partum period for prevention of exacerbations in MS.
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Mult Scler
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2000;6 (Suppl 2):S18-20.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/11188773" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11188773</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="LM555.REF.9">Haas
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J, Hommes
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OR. A dose comparison study of IVIG in postpartum relapsing-remitting multiple sclerosis.
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Mult Scler
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2007;13:900-8.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/17881400" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17881400</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="LM555.REF.10">Gan
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DC, Welsh
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B, Webster
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M. Successful treatment of a severe persistent case of pemphigoid gestationis with antepartum and postpartum intravenous immunoglobulin followed by azathioprine.
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Australas J Dermatol
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2012;53:66-9.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/22309336" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22309336</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="LM555.REF.11">Winkelmann A, Benecke R, Zettl U. Effect of intravenous immunoglobulin treatment on pregnancy and postpartum-related relapses in multiple sclerosis: A prospective, rater-blinded analysis. Neurology 2012;78 (1 Suppl):P06.</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="LM555.REF.12">Bostan
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E, Gülseren
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D, Ersoy Evans
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S, et al.
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Efficacious treatment of pemphigus vulgaris by intravenous immunoglobulin during pregnancy and postpartum period.
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Dermatol Ther
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2020;33:e13187.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/31830346" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31830346</span></a>]</div></dd></dl></dl></div></div><div id="LM555.Substance_Identification"><h2 id="_LM555_Substance_Identification_">Substance Identification</h2><div id="LM555.Substance_Name"><h3>Substance Name</h3><p>Immune Globulin</p></div><div id="LM555.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>9007-83-4</p></div><div id="LM555.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Milk, Human</p><p>Antibodies</p><p>Immunoglobulin G</p><p>Immunoglobulins</p></div></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></dl></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK501437_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Revision: <span itemprop="dateModified">October 15, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a><p class="small"><b>Attribution Statement:</b> LactMed is a registered trademark of the U.S. Department of Health and Human Services.</p></div></div><h3>Publisher</h3><p><a href="https://www.nlm.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Child Health and Human Development</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Immune Globulin. [Updated 2024 Oct 15].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/lactmed/imiquimod/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/lactmed/inclisiran/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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