Immunotherapy enhances, not replaces, antibodies

DEAR DR. ROACH »

My doctor has prescribed IVIG therapy for my peripheral neuropathy. As I understand it, this infusion will replace my antibodies with “good” antibodies. Will it replace my COVID vaccine antibodies? Or any of the other immune system antibodies my body has developed to fight off infection?

— J.K.

DEAR READER » Only some types of peripheral neuropathy are treated with intravenous immunoglobulins (immunoglobulins is another name for antibodies). One is chronic inflammatory demyelinating polyneuropathy, where the person’s immune system attacks the lining to their own nerves. In this case, the IVIG works to block the person’s antibodies to their nerve cells. IVIG is given for several other conditions, such as common variable immune deficiency, where a person isn’t capable of making enough antibodies and is at risk for infection.

In either case, the person receiving IVIG does get some benefit to fighting off infection. But I wouldn’t say the IVIG therapy “replaces” your own antibodies. It’s more like it augments them. If your neurologist has recommended the COVID-19 vaccine, that will be the primary way your body will be protected from you developing COVID-19, and especially from severe infection.

The cases I have seen of COVID-19 in people receiving IVIG have seemed to be very mild cases. Whether this is a result of the IVIG therapy or just by chance, I don’t know.

DEAR DR. ROACH » I am a 51-year-old woman who underwent a nasal septoplasty two weeks ago to correct some long-term sinus issues. While the recovery has been very uncomfortable, I would say that it has not been very painful, minus a sore nose and a few headaches. My concern comes from the fact that upon discharge from the day of surgery at the hospital, I was prescribed 60 oxycodone tablets. I find this to be an excessive amount and am wondering how I should address my concerns with my surgeon. I only ended up using one and took the remaining amount to a prescription drop-off site, but I am concerned that another patient might become addicted or allow extras to fall into the wrong hands.

DEAR READER » I honor you for knowing how many opiates to prescribe after surgery better than your surgeon seems to.