By Henry Ehrlich
One of the bonuses of running this website is the chance to attend events where real experts talk about the cutting-edge science. Last Tuesday morning I went to grand rounds at Beth Israel Medical Center In Manhattan to hear Dr. Mark Ballow, former president of the American Academy of Allergy, Asthma, and Immunology (AAAAI), who contributed our inaugural guest editorial. Mark is one of the doctors who have made the State University of New York at Buffalo a distinguished center for allergy medicine, along with our other contributor Dr. Robert Reisman.
Dr. Ballow was talking about intravenous immune globulin (IVIG), a highly refined form of the substance familiar to allergic people everywhere as IgG, which we at aac.com call IgG(ood), to distinguish it from the allergic antibody IgE(vil). IVIG was originally injected into the muscles for immune disorders, but since the 1980s, intravenous injections have proven to be very effective at boosting platelet counts and reducing inflammation. This holds promise for a large number of off-label uses, i.e. conditions for which it is not now approved, including breakthrough treatment for things like allergies, auto-immune disorders like MS, and even Alzheimer’s Disease.
As Mark said in an article* on the subject (and repeated in his talk), “In fact, the IgG molecule is the single most important naturally occurring specific immune component capable of modulating the immune system.”
Exciting though the data was, however, it was also an object lesson in why medical breakthroughs take so long to make it into clinical use and why they are so expensive. Seventy percent of IVIG applications are off-label, so gaining approval for new ones will require a good deal of extremely expensive testing and red tape. Also the basic molecule will require further refinement to work well with the alphabet soup of receptor cells involved in various conditions. But the biggest cost barrier lies in manufacturing enough of the stuff to go around. IVIG can now only be created by refining human blood plasma, and it has to be plasma with the right properties. The arithmetic is daunting. It costs $50-70 per gram. An effective dose is two grams PER KILO of body weight per month. The great hope, Dr. Ballow says, is that it can be bio-engineered to bring that cost way down. Only then will we find out whether this stuff is as promising as it sounds.
*Journal of Allergy and Clinical Immunology, Feb. 2011; page 315