Is Immune endoglobulin Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Immune endoglobulin? Is Immune endoglobulin safe for nursing mother and child? Does Immune endoglobulin extracts into breast milk? Does Immune endoglobulin has any long term or short term side effects on infants? Can Immune endoglobulin influence milk supply or can Immune endoglobulin decrease milk supply in lactating mothers?

Immune endoglobulin is a normal component of breastmilk. Data from 2 mothers indicate that IgG concentrations in milk are normal or higher and IgM levels in milk are normal or lower during IVIG therapy. The antibacterial activity of milk in these women was normal. There appears to be an emerging consensus that intravenous Immune endoglobulin is the treatment of choice for postpartum mothers with multiple sclerosis who are breastfeeding,[1][2][3][4] although one retrospective study failed to find a decrease in relapse rate among mothers who received IgG postpartum.[5] Holder pasteurization (62.5 degrees C for 30 minutes) decreases the concentration of endogenous immunoglobulin G by up to 79%.[6][7] Higher temperatures of 72 and 85 degrees C appear to cause greater loss, but further lyophylization does not cause marked additional loss.[8] A flash heating pasteurization reduced the concentration of endogenous immunoglobulin G by 33%.[9] A continuous flow, high-temperature short-time (HTST) pasteurizer at temperatures ranging from 71 to 74 degrees C retained from about 38 to 79% of IgG activity depending on the temperature and exposure time.[10] A study of 67 colostrum samples that underwent Holder pasteurization found that IgG amounts decreased by 34 to 40%. Immunoreactivity against ovalbumin decreased by 4 to 18% and immunoreactivity against tetanus toxoid decreased by 8 to 20%. Specific IgG subclasses decreased by different amounts, with IgG4 retaining all of its activity and IgG1 and 2 decreasing by about 40 to 50%.[11]

In a retrospective study of 108 women with relapsing-remitting multiple sclerosis, 69 received intravenous immunoglobulin (IVIG) postpartum. Those who received IVIG received either 0.4 g/kg daily for 5 days plus additional doses of 0.4 g/kg at 6 and 12 weeks postpartum (n = 41), or IVIG 0.4 g/kg daily for 5 days during the first 6 to 8 weeks of pregnancy, then 0.4 g/kg every 6 weeks until 12 weeks postpartum. Seventy-three percent of the 108 infants were breastfed until 3 to 12 weeks postpartum. No serious adverse event occurred in any of the infants and the mothers who breastfed had outcomes as good as those who did not.[13] A case series reported 43 women with multiple sclerosis who received 60 grams of IVIG within 3 days of delivery and 10 grams monthly. All of the women breastfed their infants for at least 4 weeks. The only adverse effect reported in infants was a transient rash one day after a maternal dose of IVIG which was possibly caused by the IVIG. The relapse rate was lower than with historical controls who did not receive IVIG.[14] A European double-blind, randomized trial compared two IVIG regimens in 168 postpartum mothers with multiple sclerosis to observe the relapse rate. One group received 150 mg/kg within 24 hours of delivery and monthly for 6 months. The other group received 450 mg/kg within 24 hours of delivery, 300 mg/kg on day 2 and 150 mg/kg on day 3 postpartum followed by monthly doses of 150 mg/kg until 6 months postpartum. More mothers who breastfed for 3 months or longer were relapse free during the study than those who did not breastfed or who breastfed less than 3 months. In all, 91 mothers breastfed for 3 months or longer and 48 mothers breastfed for less than 3 months. No mention was made of adverse effects in breastfed infants.[15] A woman with pemphigoid gestationis was treated with several courses of intravenous Immune endoglobulin 2 grams/kg over 3 days during pregnancy as well as at 4, 9 and 13 weeks postpartum. She was also receiving prednisolone in a dosage tapering from 0.7 mg/kg daily to 1 mg daily. She breastfed her infant (extent not stated) for 3 months with no problems noted.[16] In a study comparing the timing of intravenous Immune endoglobulin on the relapse of relapsing-remitting multiple sclerosis, 24 patients were treated with intravenous Immune endoglobulin starting in the first 24 hours after delivery and during lactation. The authors concluded that intravenous Immune endoglobulin is effective in reducing the frequency of postpartum-related relapses. No adverse effects were noted. Further details were not provided in the published abstract.[17]