To the Editor: We are concerned that Yuki and Hartung (June 14 issue),(1) in their otherwise comprehensive review of the Guillain-Barré syndrome, have overlooked the importance of public health efforts in the surveillance of acute flaccid paralysis to the eradication of polio. Surveillance of acute flaccid paralysis, and hence Guillain-Barré syndrome, which the authors describe as the "most frequent cause of acute flaccid paralysis worldwide," is a key strategy in global efforts aimed at its eradication.(2) The recent declaration by the World Health Assembly that poliovirus eradication is a programmatic emergency for global public health(3) should convince clinicians around the . . .
[Show abstract][Hide abstract] ABSTRACT: Therapy by human immunoglobulin G (IgG) concentrates is a success story ongoing for decades with an ever increasing demand for this plasma product. The success of IgG concentrates on a clinical level is documented by the slowly increasing number of registered indication and the more rapid increase of the off-label uses, a topic dealt with in another contribution to this special issue of Frontiers in Immunology. A part of the success is the adverse event (AE) profile of IgG concentrates which is, even at life-long need for therapy, excellent. Transmission of pathogens in the last decade could be entirely controlled through the antecedent introduction by authorities of a regulatory network and installing quality standards by the plasma fractionation industry. The cornerstone of the regulatory network is current good manufacturing practice. Non-infectious AEs occur rarely and mainly are mild to moderate. However, in recent times, the increase in frequency of hemolytic and thrombotic AEs raised worrying questions on the possible background for these AEs. Below, we review elements of non-infectious AEs, and particularly focus on hemolysis and thrombosis. We discuss how the introduction of plasma fractionation by ion-exchange chromatography and polishing by immunoaffinity chromatographic steps might alter repertoire of specificities and influence AE profiles and efficacy of IgG concentrates.
Frontiers in Immunology 02/2015; 6:11. DOI:10.3389/fimmu.2015.00011
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