TREATMENT DATABASE

Gamma globulin is a class of blood plasma proteins that contain antibodies. It is a blood product pooled from many donors and processed so that it contains a high concentration of immunoglobulin G (IgG) and other antibodies that mitigate against and prevent certain diseases. Gamma globulin has been in use for more than 40 years to prevent hepatitis, particularly in health care workers, as a prophylactic during epidemics of measles and rubella, as an immune modulator in Kawasaki syndrome and in myasthenia gravis (a disease that affects the muscles).

USES IN ME/CFS: Gamma globulin was one of the earliest ME/CFS treatments. The rationale behind the use of gamma globulin is twofold. It was reasoned that if ME/CFS were caused by a virus, particularly a common virus that most of the general public had been exposed to (such as Epstein-Barr virus), gamma globulin would contain certain antibodies to fight the virus.

In addition, certain patients with ME/CFS had demonstrated deficiency of IgG subclasses and it was proposed that gamma globulin could correct this deficiency. While gamma globulin has sometimes been helpful in treating ME/CFS, it is not easy to determine why. It seems that patients who demonstrate IgG deficiency do not always respond better to gamma globulin therapy than do those without IgG deficiency. Several studies, both controlled and open, have been completed in the United States and other countries with inconclusive results.

• In 1986 Dr. James Oleske and colleagues from the New Jersey School of Medicine in Newark conducted an open trial of 12 patients with chronic Epstein-Barr virus infection (ME/CFS) with IgG or IgG subclass deficiency. These patients underwent intravenous gamma globulin therapy for one year. Symptoms improved in eight and showed no improvement in four, but did not worsen in any patients.

• Also in 1986, Dr. Richard DuBois of Atlanta, Georgia, reported the results of a double-blind controlled study of patients with chronic mononucleosis syndrome (ME/CFS) treated with intramuscular gamma globulin. Symptoms in 52% of the patients who received gamma globulin improved after treatment.

• In 1988 Dr. Phillip Peterson of the University of Minnesota headed a double-blind controlled trial of intravenous gamma globulin in 30 patients with ME/CFS. Patients received an infusion of gamma globulin every month for 6 months. Of these 30 patients, 12 (40%) had low IgG concentrations and 29 (9%) had a viral onset. Given the immunological deficiencies, a presumed viral component, and a severely affected group of patients, the results fell short of expectations. No significant difference was demonstrated between the placebo and drug responses.

• In 1991 Dr. Denis Wakefield of Sydney, Australia, concluded a study of 49 patients with ME/CFS enrolled in a double-blind placebo-controlled study of intravenous gamma globulin. Twenty-three patients received gamma globulin infusions over 90 days, with encouraging results. Symptoms in 10 patients improved. In addition, several immune parameters tested showed improvement after treatment. Some side effects were reported, but they may have been due to the high dose of gamma globulin. Dr. Wakefield and his colleagues reported interest in undertaking a larger trial with a lower dose of gamma globulin.

• In 1997 Australian pediatrician Dr. K.S. Rowe published the results of a study of 70 adolescents (ages 12 to 18 years) with chronic fatigue syndrome who received intravenous gamma globulin therapy. After three months of treatment, significant improvement was noted, but there were some side effects.

• In 2001 Dr. Rowe's long-term study of pediatric patients who were followed for seven years also showed that patients experienced significant improvement. 

Treatment rating for Gamma Globulin