[Immunoglobulins--merely expensive or also useful?].

About 15 years ago, treatment with intravenous immune globulin (IVIG) for primary immunodeficiency diseases was introduced. The concept of replacement of deficient circulating antibodies to prevent infections in these patients subsequently proved to be beneficial. Up-to-date IVIG therapy is considered to be the treatment of choice in many primary or secondary immunodeficiency states. The observation of a significant increase in the platelet count in patients with agammaglobulinemia and severe thrombocytopenia after IVIG therapy developed interest in possible modulatory effects of IVIG on the immune system. Although the mode of action of IVIG in autoimmune diseases is not completely understood, therapeutic benefit has been shown in some diseases. It has to be stated that IVIG in autoimmune diseases are rarely first therapeutic choice; however, IVIG might be indicated in patients where conventional and cheaper therapy has failed. This review summarizes the status of IVIG therapy in primary and secondary immunodeficiency states and possible indications in autoimmune diseases.