Diarrhea as a Side Effect of IV Immunoglobulin
Yes, diarrhea is a recognized adverse effect of intravenous immunoglobulin (IVIG) therapy, though it is generally mild and transient. 1, 2
Frequency and Severity
Diarrhea occurs as part of the immediate adverse reaction profile of IVIG, typically manifesting within the first 6 hours of infusion alongside other gastrointestinal symptoms including nausea and vomiting 1, 2
The overall incidence of immediate adverse events ranges from 24-36% in large patient series, with diarrhea being among the less common gastrointestinal manifestations compared to nausea 1
Most gastrointestinal adverse effects are mild and self-limiting, not requiring discontinuation of therapy 3, 1
Clinical Characteristics
Diarrhea from IVIG is typically transient and resolves without specific intervention beyond supportive care 2
The symptom occurs as part of the immediate reaction spectrum, which includes headache, flushing, fever, chills, myalgia, fatigue, and blood pressure changes 1, 2
In patients with immune system disorders receiving IVIG, diarrhea should be distinguished from other potential causes including underlying disease activity, concurrent infections (particularly Clostridium difficile), or other medications 4
Risk Factors and Prevention
High infusion rates, high doses, and concurrent infections may worsen adverse effects, particularly in patients with primary immunodeficiency diseases 3
Slow infusion rates and adequate hydration are key preventive measures that reduce the risk of most IVIG-related adverse events, including gastrointestinal symptoms 1, 2
Patients at higher risk for adverse events include the elderly, those with renal disease, and those receiving rapid infusions 5, 2
Management Approach
If diarrhea occurs during infusion, slow or temporarily discontinue the infusion and provide symptomatic treatment 2
Most patients can continue IVIG therapy after rate adjustment, as only severe reactions (such as anaphylaxis in IgA-deficient patients) require permanent discontinuation 3, 2
For patients with persistent or severe diarrhea, evaluate for alternative etiologies including infectious causes (C. difficile, CMV, other pathogens) and medication-related causes 4
Important Caveats
Do not confuse IVIG-induced diarrhea with immune checkpoint inhibitor-related colitis, which is a distinct entity with different pathophysiology and management requiring immunosuppression 4
In the specific context of C. difficile infection, IVIG may actually be therapeutic rather than causative, as it has been used successfully as adjunct therapy in severe, refractory cases 4, 6
Pre-medication does not significantly reduce the rate of adverse events, so focus should be on proper infusion technique rather than prophylactic medications 3