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Letter to the Editor
Five years of self-administered hyaluronidase facilitated subcutaneous immunoglobulin (fSCIg) home therapy in a patient with primary immunodeficiency
  1. Emily Carne1,
  2. Mark Ponsford1,
  3. Tariq El-Shanawany1,
  4. Paul Williams1,
  5. Trevor Pickersgill2,
  6. Stephen Jolles1
  1. 1Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
  2. 2Department of Neurology, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Stephen Jolles, Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, CF14 4XW, UK; jollessr{at}cardiff.ac.uk

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Following Bruton's introduction of immunoglobulin replacement in 1952,1 intramuscular immunoglobulin was the major route used, but was limited by the volume which could be given, reactions and painful administration. Improved manufacturing techniques led to the use of safe intravenous immunoglobulin products allowing higher replacement volume, maintaining physiological serum immunoglobulin levels. Using portable syringe drivers2 and with the development of higher concentration products, subcutaneous immunoglobulin (SCIg) became increasingly popular using different regimens including weekly, bi-weekly and rapid push. More recently hyaluronidase facilitated SCIg (fSCIg) using recombinant human hyaluronidase in combination with 10% immunoglobulin (Kiovig)3 has become available allowing over 600 mL to be given at a single site resulting in fewer needles, infusions and an adverse event profile closer to conventional SCIg with improved bioavailability.4

It is remarkable that Bruton pioneered SCIg in 1952 and in a later follow-up report 10 years later introduced hyaluronidase facilitated intramuscular immunoglobulin.5

Information regarding long-term local side effects of fSCIg remains limited with current trials describing 21–28 infusions at a single site. We summarise and extend previously reported data at initiation of therapy6 to describe the longest reported continuous administration of fSCIg home therapy with assessment …

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