Is Varicella Zoster Virus (VZV) antibody Immunoglobulin G (IgG) indicated before starting Intravenous Immunoglobulin (IVIG) therapy?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Article Review Status
Submitted
Under Review
Approved

Last updated: April 6, 2025 • View editorial policy

From the Guidelines

Testing for Varicella Zoster Virus (VZV) antibody IgG is not routinely indicated before starting IVIG (Intravenous Immunoglobulin) therapy. IVIG products are derived from pooled plasma of thousands of donors and already contain antibodies against common pathogens including VZV 1, 2. Therefore, patients receiving IVIG will passively acquire VZV antibodies through the treatment itself, providing some protection against varicella infection. The presence or absence of pre-existing VZV immunity in the patient does not typically influence the decision to initiate IVIG therapy or its dosing. IVIG is prescribed based on the underlying condition requiring immunoglobulin replacement or immunomodulation, such as primary immunodeficiency disorders, certain autoimmune conditions, or specific neurological disorders.

However, in special circumstances where a patient's VZV immunity status might affect other concurrent treatments or risk assessments, testing could be considered, but this would be situation-specific rather than a standard practice before IVIG initiation 3, 4. For example, patients with certain immunocompromised conditions may require vaccination against varicella before starting immunosuppressive therapy, and testing for VZV IgG could be useful in determining their immunity status 5. Nevertheless, the most recent and highest quality study suggests that IVIG therapy itself provides sufficient protection against varicella, making routine testing for VZV IgG unnecessary 2.

Key points to consider:

  • IVIG products contain antibodies against VZV, providing passive immunity to patients receiving IVIG therapy
  • Pre-existing VZV immunity does not typically influence IVIG therapy or dosing
  • Special circumstances may require testing for VZV IgG, but this is not a standard practice before IVIG initiation
  • The most recent and highest quality study supports the use of IVIG therapy as sufficient protection against varicella, making routine testing for VZV IgG unnecessary 2

From the Research

Varicella Zoster Virus Antibody IgG and IVIG

  • The indication of Varicella Zoster Virus (VZV) antibody IgG before starting Intravenous Immunoglobulin (IVIG) is not directly addressed in the provided studies 6, 7, 8, 9, 10.
  • However, the studies suggest that VZV IgG antibody titers can be used to determine immunity to VZV infection 8, 9, 10.
  • One study found that the median VZV IgG antibody titers of patients with herpes zoster were significantly higher than those of healthy controls 9.
  • Another study evaluated the diagnostic usefulness of VZV-specific IgG antibodies in patients with herpes zoster and found that a four-fold or higher increase in VZV IgG antibody titer was observed in 36.4% of patients 9.
  • The use of IVIG in treating severe viral infections, including VZV, is mentioned in one study, which examined the functional differences between antiviral activities of sulfonated and intact IVIG preparations toward VZV and cytomegalovirus 7.
  • However, the study does not provide information on the indication of VZV antibody IgG before starting IVIG.

VZV IgG Antibody Detection

  • Several studies evaluated the performance of different enzyme-linked immunosorbent assays (ELISAs) for detecting VZV-specific IgG antibodies 8, 10.
  • One study found that the Enzygnost anti-VZV/IgG and the Serion ELISA Classic VZV IgG showed high sensitivities of 99.6% and 99.2%, respectively 8.
  • Another study evaluated the novel RIDASCREEN VZV IgG EIA and found that it had comparable sensitivity to the SERION ELISA classic VZV IgG and higher sensitivity than the ELISA Enzygnost Anti VZV/IgG 10.
  • The studies suggest that VZV IgG antibody detection can be useful in determining immunity to VZV infection, but the indication of VZV antibody IgG before starting IVIG is not directly addressed.

References

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.