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A total of 377 glycans were screened for binding of IgG using commercial IVIg brands Sandoglobulin (A), Privigen (B), and Gamunex (C) or a control mix of human myeloma (D; containing IgG1 and IgG2 in a 2:1 proportion, similar to IVIg). Glycan binding for each was tested at 180 μg/ml. As examples the carbohydrate structures of several of the top IVIg bound glycans are shown.

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A) Glycan-binding patterns of the Sandoglobulin IVIg as measured by relative fluorescence units (RFU) and ranked in descending order of signal (grey bars) paired with the results of the control IgG mix (black bars). Binding of IVIg to 181 glycans (48%) was above background, as defined by the highest signal of the control IgG mix (dotted horizontal line). B) Comparison of glycan binding activities of Sandoglobulin, Privigen and Gamunex. Values are indicated as net fluorescence units (NFU) as calculated by subtraction of the corresponding glycan binding value for the IgG control mix. The majority of glycans were recognized with comparable binding intensity by the three IVIg preparations (r2 from left to right: 0.82, 0.81 and 0.88).

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Results: Based on the most recent search conducted on May 31, 2022, the IDSA guideline panel has made 29 recommendations for the treatment and management of the following groups/populations: pre- and post-exposure prophylaxis, ambulatory with mild-to-moderate disease, hospitalized with mild-to-moderate, severe but not critical, and critical disease. As these are living guidelines, the most recent recommendations can be found online at:

There has been an expanding number of studies rapidly published online and in academic journals; however, some of these may be of limited quality and are pre-published without sufficient peer-review. Critical appraisal of the existing studies is needed to determine if the existing evidence is sufficient to support currently proposed management strategies.

Privigen AU (Human Normal Immunoglobulin 10% [100 mg/mL] available in vial sizes 5g/50mL, 10g/100mL and 20g/200mL is an Australian normal immunoglobulin product manufactured by CSL Behring and accessed under the National Blood Supply (NBS) arrangements.

Commercial IVIG preparations, including Immunovenin-intact, Hizentra, Sandoglobulin and two different lots of Privigen, all similarly induced cytokine-dependent death of human, but not mouse, neutrophils. Absence of IVIG-mediated death was confirmed in different death assays, including flow cytometric assessment of Annexin-V/PI staining or ethidium bromide exclusion, DNA fragmentation, mitochondrial potential measurement, and morphological analysis. These data demonstrate that IVIG mediates death of human neutrophils by the action of specific antibodies directed to targets that are recognized and functional in human, but not in mouse neutrophils.

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