Immunoglobulin replacement therapy (IVIG)
A treatment that replaces missing antibodies using a drip into a vein, given regularly to people with certain immune deficiencies to reduce serious infections.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- IVIG replaces antibodies the immune system cannot make enough of, given by a drip into a vein, usually every 3–4 weeks, to reduce serious infections.
- It is a human blood product made from many donors; the risk of passing on infection is very low but not zero, and consent should cover sourcing, safety and alternatives.
- It reduces but does not abolish infections and does not cure the underlying condition; for many people it is a lifelong treatment that needs regular review.
- Reactions can happen during or after an infusion — tell staff at once about chest tightness, breathlessness, a bad headache, fever or a rash.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Replaces antibodies the body cannot make, reducing the number and severity of infections
Conditions where immunoglobulin has no proven benefit — it should not be used for unproven indications, given it is a limited blood product.
Staff monitor you, as most reactions happen while the drip is running. Slowing the rate often settles mild symptoms such as headache, flushing or aches.
A named contact and clear plan for reactions, missed infusions and new infections.
Staff monitor you, as most reactions happen while the drip is running. Slowing the rate often settles mild...
You are observed for a period after the infusion finishes, then usually go home. You may feel tired and should...
Headache, tiredness or aching can linger and then settle. A severe headache with neck stiffness should be...
Infusions are repeated, usually every 3–4 weeks, with the dose and timing adjusted to your antibody levels and how...
What is immunoglobulin replacement therapy (IVIG)?
Immunoglobulin replacement therapy gives a person the antibodies (immunoglobulins) their own immune system cannot make enough of. Antibodies are proteins that help fight infection. In the intravenous form, known as IVIG, the immunoglobulin is given through a drip into a vein, usually every three to four weeks.
It is important to understand that immunoglobulin is a human blood product. It is made from plasma pooled from thousands of blood donors and goes through careful steps to reduce — but never entirely remove — the theoretical risk of passing on infection. In the UK, plasma for these medicines has historically been imported because of concerns about variant CJD; sourcing and safety are taken very seriously, and your team should explain them.
IVIG is used as replacement treatment for people who lack working antibodies — such as some primary (inherited) immunodeficiencies and certain secondary (acquired) ones — to reduce the number and severity of infections. The same medicine is also used at higher doses to calm the immune system in some other conditions, but this guide focuses on its use as antibody replacement.
The treatment can make a major difference to infections and quality of life, but it is not a cure for the underlying condition, it does not stop every infection, and for many people it is a lifelong treatment that needs regular review.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
IVIG compared with subcutaneous immunoglobulin (SCIG)
| IVIG (into a vein) | SCIG (under the skin) | |
|---|---|---|
| How often | Usually every 3–4 weeks | Often weekly or more often |
| Where | Hospital, day unit or supervised home | Usually self-given at home |
| Systemic reactions | More likely | Less likely |
| Local site reactions | Cannula site only | More common (under the skin) |
Neither is simply better; the choice depends on your veins, lifestyle, side effects and preference. Many people can switch between them.
Preparing for your treatment
- Make sure you understand why IVIG is recommended, what it can and cannot do, and that it is a human blood product — ask about sourcing and safety.
- Tell your team about any previous reactions to infusions or blood products, and about IgA deficiency if known.
- Mention all medicines and any kidney problems, heart problems, or a history of blood clots, as these affect safety.
- Tell your team if you might be pregnant, are pregnant, or are breastfeeding.
- Have any baseline blood tests done as requested, and be up to date with agreed vaccinations before starting where advised.
- Plan for the infusion to take a few hours, and arrange to take it easy afterwards in case you feel tired or headachy.
- Drink normally and stay hydrated around the infusion, as advised by your team.
What happens
Before the infusion, staff check your details, recent blood tests and the immunoglobulin product and batch number, which are recorded for safety. A thin tube (cannula) is placed in a vein, usually in the arm or back of the hand.
The immunoglobulin is given slowly through the drip, often starting at a low rate and increasing if you are comfortable. Each infusion usually takes about two to four hours. Staff monitor you during the infusion — checking things like your temperature, pulse and blood pressure — because most reactions happen while it is running or shortly afterwards.
Some people are given medicines beforehand (such as paracetamol or an antihistamine) to reduce reactions, and slowing the rate often settles mild symptoms. After the infusion, you are observed for a time before going home. Over the following weeks, your antibody (IgG) levels and how you feel guide the dose and timing of future infusions.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Conditions where immunoglobulin has no proven benefit — it should not be used for unproven indications, given it is a limited blood product.
- People with severe IgA deficiency and antibodies to IgA may need special products and extra caution because of reaction risk.
- Significant kidney impairment, uncontrolled heart failure or a high risk of clots may make treatment unsafe without careful planning.
- A known severe reaction to immunoglobulin without a safe plan to manage it.
Delay or rearrange if…
- You have an active severe infection or are acutely unwell, until reviewed by your team.
- Your kidney function or blood counts are unstable and need checking first.
- You are pregnant, may be pregnant, or are breastfeeding and this has not yet been discussed.
- Baseline tests, consent or the right product and batch records are not yet in place.
Alternatives to discuss
- Subcutaneous immunoglobulin (under the skin), often self-given at home, as an alternative route.
- Preventive antibiotics and vaccination, which may be enough in milder antibody deficiency.
- Treating the underlying cause in secondary immunodeficiency, which may improve immunity.
- Watchful waiting with prompt treatment of infections where replacement is not yet justified.
- No replacement if the criteria are not met, with regular review.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Replaces antibodies the body cannot make, reducing the number and severity of infections
- Can prevent the serious infections that damage the lungs and other organs over time
- Often improves day-to-day wellbeing and reduces hospital admissions
- Can be life-changing for people with significant antibody deficiency
- Dose can be adjusted to your needs and response
- An alternative route (under the skin) is available if veins or reactions are a problem
Risks & complications
- Headache, tiredness, aching, chills or a mild fever during or after the infusion
- Flushing, nausea or muscle aches that often ease if the drip is slowed
- Discomfort or bruising at the cannula site
- Symptoms that can last a day or two after the infusion
- A more troublesome reaction needing the infusion to be slowed or paused
- A severe headache, sometimes with neck stiffness, in the days afterwards (aseptic meningitis-type reaction)
- Skin rashes
- Needing to change brand or premedication because of repeated reactions
- A serious allergic reaction during the infusion (more likely in people with severe IgA deficiency)
- Blood clots, kidney problems, or breakdown of red blood cells (haemolysis)
- A serious lung reaction (transfusion-related acute lung injury)
- Theoretical risk of a blood-borne infection, despite rigorous donor screening and viral-inactivation steps
The biggest issues to discuss are that immunoglobulin is a pooled human blood product with a very low but not zero infection risk, that serious reactions and clots are rare but real, and that the treatment is often lifelong. People with severe IgA deficiency, kidney problems, heart problems or a history of clots need extra care. Make sure you know which product you receive, that the batch is recorded, and exactly what symptoms should prompt you to tell staff or seek urgent help.
Published figures to discuss
Reaction rates vary widely between people, products and infusion rates, and serious events are rare, so we describe risks honestly in words rather than giving precise percentages that could mislead. Slower infusion rates, premedication and staying on the same product reduce reactions. The notes below are cautious and general.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Mild infusion reactions (headache, chills, aches, flushing) | Common, especially early on | Often settle if the infusion is slowed or with premedication; tend to lessen over time. | Guide sourcesClinical context |
| Severe allergic (anaphylactic) reaction | Rare | More likely in people with severe IgA deficiency and anti-IgA antibodies; needs a clear emergency plan. | Guide sourcesClinical context |
| Blood clots, kidney problems, haemolysis or serious lung reaction | Rare, but important | Higher with risk factors such as existing kidney or heart disease, clotting tendency or high doses; monitoring helps detect them. | UK plasma for immunoglobulins and vCJD risk assessment — GOV.UKgov.ukSource-linked context |
| Transmission of a blood-borne infection | No confirmed cases with modern viral-inactivated products, but not zero in theory | Donors are screened and manufacturing inactivates or removes viruses; product and batch are recorded for traceability. | UK plasma for immunoglobulins and vCJD risk assessment — GOV.UKgov.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no surgical recovery, but the infusion itself takes a few hours and some people feel washed out, headachy or achy for a day or two afterwards. 'Afterwards' is mainly about watching for reactions and judging, over months, whether infections are reducing.
- Mild headache, tiredness or aching for a day or two after an infusion
- Flushing or mild chills during the drip that ease when it is slowed
- Some discomfort or bruising at the cannula site
- Infections becoming fewer and milder gradually, rather than stopping at once
- Needing regular infusions and blood tests for the long term
Aftercare
- Keep a record of which immunoglobulin product and batch you have had at each infusion.
- Take it easy on the day and stay hydrated, as advised by your team.
- Use simple pain relief for a mild post-infusion headache if your team agrees.
- Report a severe headache, neck stiffness, breathlessness, chest pain, dark urine, or leg swelling promptly.
- Attend for regular blood tests so your antibody levels and organ function can be checked.
- Keep up agreed vaccinations and infection-prevention advice, and seek help early for new infections.
- Tell any other clinician that you receive immunoglobulin, especially before procedures or new medicines.
- Reason for IVIG and what it can and cannot do understood
- Consent covering blood-product sourcing, safety and alternatives completed
- Record of product and batch numbers kept
- Baseline blood tests and any pre-treatment vaccines done
- Plan to rest and stay hydrated on infusion days
- List of symptoms that need urgent help saved
- Contact route for the immunology or homecare team to hand
Scars and how they heal
There is no surgical scar. A thin tube (cannula) is placed in a vein, usually in the arm or back of the hand, for each infusion. This can leave temporary bruising or tenderness at the site, and people who have many infusions over years may find their veins become harder to use. There are no incisions and no permanent scarring; the subcutaneous (under-the-skin) route is an alternative if veins become difficult.
⚠ Get urgent help if…
- Difficulty breathing, wheezing, chest tightness or swelling of the face, lips or tongue during or after the infusion — call for help immediately
- Feeling faint, a fast heartbeat or collapse
- A severe headache, especially with neck stiffness, fever or dislike of light, in the days after an infusion
- Dark or reduced urine, or marked tiredness and breathlessness (possible kidney problem or haemolysis)
- Swelling, pain or redness in a leg, or sudden breathlessness or chest pain (possible blood clot)
- A high fever or signs of a new serious infection
- Signs of sepsis: confusion, very fast breathing, mottled or pale skin — call 999
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is a clear reduction in how often and how severely you get infections, fewer courses of antibiotics and hospital admissions, and protection of your lungs and other organs over time. Your team checks your antibody (IgG) level and, more importantly, how you actually feel, to judge whether the dose and timing are right.
IVIG cannot cure the underlying immune condition and does not stop every infection. The benefit builds up over months rather than immediately, and the dose is fine-tuned to you. A 'good level' on a blood test matters less than whether your infections are genuinely fewer and milder.
For many people with antibody deficiency, immunoglobulin replacement is a long-term, often lifelong treatment, because the underlying problem does not go away. In secondary immunodeficiency, treatment may sometimes be stopped and reviewed if the underlying cause improves — for example after recovery of antibody production following certain medicines. The need for treatment is reviewed regularly, and the route (vein or under the skin) can be changed to suit you over time.
Related tests, treatments or support
Immunoglobulin replacement is usually combined with other infection-prevention measures, such as agreed vaccinations and sometimes preventive antibiotics, and with treatment of any complications such as lung damage. It is coordinated with the team treating any underlying condition. The intravenous and subcutaneous routes are alternatives, and people often move between them depending on their veins, side effects and lifestyle.
Follow-up & long-term care
Follow-up includes regular infusions and blood tests, with specialist review to check your antibody levels, organ function, how you feel and whether infections are reducing. Ask who to contact about reactions, missed infusions or new infections between appointments, and make sure the product and batch you receive are always recorded.
- Attend regular infusions, usually every 3–4 weeks for IVIG
- Have blood tests to monitor antibody levels and kidney and blood counts as advised
- Keep a personal record of product and batch numbers
- Keep agreed vaccinations and infection-prevention measures up to date
- Report new or changing infections, and any reactions, promptly
- Attend regular specialist review to confirm the treatment is still right for you
Repeat, follow-on and what comes next
- The dose and interval are adjusted over time to your antibody levels and how you feel.
- Some people switch products because of reactions, or switch between the vein and under-the-skin routes.
- In secondary immunodeficiency, treatment may be paused and reviewed if antibody production recovers.
- Treatment is reviewed regularly to confirm it is still needed and still working.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named contact and clear plan for reactions, missed infusions and new infections.
- A personal record of product and batch numbers at every infusion.
- Scheduled blood tests for antibody levels, kidney function and blood counts.
- Regular specialist review of whether treatment is working and still needed.
- Coordinated infection-prevention advice and care with any team treating an underlying condition.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The immunoglobulin product itself, which is a costly human blood product in limited supply
- The dose, which depends on your weight and antibody levels
- How often infusions are needed and where they are given (day unit or supervised home)
- Nursing time, monitoring and any premedication
- Regular blood tests and specialist review
- Management of any reactions or complications
- The cost of the immunoglobulin product and the planned dose and frequency
- Facility and nursing fees for each infusion
- Whether monitoring, premedication and observation time are included
- The cost of regular blood tests and specialist review
- What happens, and what it costs, if you have a reaction or need a brand change
- Whether home infusion and its support are included if relevant
- Cancellation policy and arrangements if supply is restricted
On the NHS? Immunoglobulin replacement is provided on the NHS for approved indications under a managed national programme because it is a limited human blood product; private provision exists but is also subject to supply and clear clinical criteria.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told clearly that immunoglobulin is a pooled human blood product with a very low but not zero infection risk.
- No discussion of the subcutaneous alternative or of stopping criteria.
- Product and batch numbers not recorded, losing traceability.
- No clear emergency plan for reactions, especially in IgA deficiency.
- Judging success only by a blood level rather than by whether infections are actually fewer.
Marketing red flags
- Offering immunoglobulin for tiredness, general 'immune boosting' or unproven indications.
- Downplaying that it is a human blood product or skipping sourcing and safety information.
- No mention of the subcutaneous alternative or of regular review.
- Promising it will stop all infections or cure the underlying condition.
- Not recording the product and batch, or not monitoring during infusions.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Why is IVIG right for me rather than the subcutaneous route, and could I switch later?
- What product will I receive, and how will the batch be recorded?
- What are my personal risks, given my kidneys, heart, clotting history or any IgA deficiency?
- What reactions should I expect, and exactly when should I seek urgent help?
- How will we judge whether it is working, beyond the blood level?
- Is this likely to be lifelong, and how often will my need for it be reviewed?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is immunoglobulin a blood product, and is it safe?
Why every few weeks, and is it forever?
Will it stop me getting infections?
What are the main risks?
Could I have it at home or under the skin instead?
Can I get IVIG privately?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Clinical guidelines for immunoglobulin use (UK Department of Health) — GOV.UK Immunodeficiency UK — immunoglobulin therapy Q&A UK plasma for immunoglobulins and vCJD risk assessment — GOV.UK Adverse effects of immunoglobulin therapy — PMC Immunoglobulin use in immune deficiency in the UK (UKPID and national databases) — PMC UK Primary Immunodeficiency Network (UKPIN)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Subcutaneous immunoglobulin therapy · Primary immunodeficiency diagnosis · Secondary immunodeficiency assessment · Clinical immunology consultation · Recurrent infection assessment