Immunology - Home Therapy with Subcutaneous Immunoglobulin

You have been diagnosed with antibody deficiency, which means your body does not make enough antibodies to fight infections.

To help protect you, your clinical team has recommended subcutaneous immunoglobulin (SCIg) replacement
therapy. Immunoglobulin (also called antibodies) is a treatment that helps your immune system work properly.

Subcutaneous (often called SC or under the skin) is a way of giving medicine using a small needle that is inserted into the soft, fatty layer just beneath your skin. This area has fewer blood vessels than muscle, so the medicine is absorbed slowly and steadily into your body.

Some patients may only need treatment for a short time, while others need it long term. This depends on your condition and how your immune system responds.

At Salford Care Organisation (SCO), we offer a subcutaneous home therapy training program for patients and their carers.

Immunoglobulin therapy can be safely administered at home, at a time that works best for you.

This removes the need to take time away from work, school, or college for hospital appointments and helps treatment fit more easily into your routine.

Home therapy also provides greater independence, giving you more control and confidence in managing your own care.
 
Our team will guide you step by step, teaching you how to administer your own subcutaneous infusions safely and confidently in preparation for self‑administering at home.

You will receive full support from the Immunology Nursing Team throughout your training, and we will continue to work with you until both you and your nurses feel completely confident that you can manage your treatment independently.

The Immunology Nursing Team will arrange everything you need via a homecare company who will:

• Supply your immunoglobulin products
• Provide the equipment you need
• Deliver items directly to your home

The nursing team will inform your GP that you have been trained to self-administer your immunoglobulin treatment at home, so they stay fully updated with your care.

We will make sure you are fully set up and supported before you start.

Methods of Subcutaneous Immunoglobulin (SCIG)

Administration

There are a few options for how you can administer your SCIg at home:

Using a Pump

Subcutaneous immunoglobulin can be administered using a small infusion pump that slowly delivers the medicine under the skin through two or more fine needles. The pump controls the infusion rate, making the process steady and comfortable. Sites for administration are usually lower abdomen, thighs, or upper arms.

Infusions usually take up to 1-2 hours and are typically administered once a week, depending on your prescribed dose. This method is convenient for home use and provides a consistent level of immunoglobulin in the body.

Rapid Push

This is a method of administering subcutaneous immunoglobulin (SCIG) using a small syringe and needle to manually “push” the immunoglobulin under the skin. It is an alternative to using an infusion pump. During rapid push, you slowly administer small amounts of immunoglobulin at a controlled rate by gently pushing the plunger of the syringe over several minutes. This allows the immunoglobulin to be absorbed into the fatty tissue under the skin.

Rapid push infusions are usually administered into the lower abdomen, thighs, or upper arms, depending on your comfort and preference.

Facilitated Subcutaneous Immunoglobulin (fSCIg)

Facilitated subcutaneous immunoglobulin is a way of administering immunoglobulin under the skin using a medicine called Hyaluronidase. Hyaluronidase temporarily helps the subcutaneous tissue absorb fluid more easily, allowing a larger dose of immunoglobulin to be administered at a single infusion site.

With fSCIG, the larger volume means you can usually have your treatment every 3–4 weeks

Hyaluronidase is infused first to open up the subcutaneous tissue. The immunoglobulin is then administered into the same site, usually over 1–2 hours.

After completing your infusion, whichever way you have administered, the tissues will absorb the immunoglobulin slowly for approx. 48 hours.

Together we will help you choose the method that feels most comfortable and fits your routine.

Home Therapy Training - What to Expect

Before your training begins, the Immunology Specialist Nurse will talk with you about whether you are comfortable having your treatment at home. This discussion will involve how your deliveries will arrive and how to safely store the immunoglobulin and equipment.

Your home therapy training will start on the Day Unit at SCO with one of the Immunology Specialist Nurses.

During your first visit, you will:

• Receive information about home therapy and how the treatment process works
• Be shown all the equipment used for infusions
• Have your initial infusion administered by the specialist nurse

If a relative or carer is supporting you at home, they will need to attend all training sessions.

At your follow‑up sessions, you will be preparing and administering the infusion yourself, with the nurse supervising and guiding you. Most people require six to eight weekly sessions, though this can vary depending on your confidence and individual needs.

We tailor the training to your learning style and can use tools such as photos or videos to help make the process clearer and easier.

Once training is complete, we will ask you to fill out a short questionnaire to make sure you feel confident and understand every part of the process. If you have any worries or difficulties, these will be discussed and addressed before you begin treating yourself at home.

When you are ready, the Immunology Nursing Team will contact the homecare company to arrange delivery of your immunoglobulin and equipment directly to your home. If needed, we can also arrange a home visit to check your set-up and provide any additional support, so you feel fully prepared to start home therapy independently.

Managing your treatment at home

Once you begin administering your immunoglobulin at home, there are a few important steps you must follow to ensure your treatment continues safely and without interruption:

Complete your infusion log after every treatment

It is essential to record the batch number of your immunoglobulin on your log form (which will be provided). Please send the completed forms to the Immunology Team by post or email.

Batch numbers must be submitted regularly

Immunoglobulin batch numbers are recorded on a national NHS England database. If we do not receive your batch numbers, your prescription cannot be renewed, and your treatment may be cancelled.

Ongoing monitoring

Your blood tests will be monitored every six months. We will discuss arrangements for obtaining these samples during your clinic appointments.

Administering your immunoglobulin treatment regularly helps keep your immune system protected. If doses are missed or delayed, the level of protection in your body may gradually reduce. This can make you more likely to experience common infections, such as coughs, colds, or sinus problems. It can also increase the risk of developing more serious infections such as pneumonia. In some cases, this can lead to potentially life‑threatening complications.

Staying on track with your treatment helps:

• Maintain steady protection
• Reduce how often infections occur
• Support your overall wellbeing
• Protect your long‑term health

Keeping to your treatment schedule gives your body the best chance to stay well. If you find it difficult to keep up with your treatment for any reason, please contact the Immunology Nursing Team. We are here to help and can offer support to make your treatment routine as easy and manageable as possible.

You should only delay your immunoglobulin infusion if you are experiencing:

• Flu‑like symptoms (such as feeling achy, shivery, or unwell)
• A temperature or fever
• An active infection - If you have been taking antibiotics for more than 48 hours and are feeling well, you may restart your infusions

If you administer your infusion when you are already unwell - for example, if you have a high temperature - you may be at a higher risk of experiencing side effects and reacting to the immunoglobulin.

If any of these symptoms occur, please wait until you are feeling better before administering your infusion. If you are unsure whether to go ahead, or if your symptoms continue, please contact the Immunology Nursing Team for advice and support. We are here to help.

Possible Side Effects of Subcutaneous Immunoglobulin (SCIg)

Most people tolerate SCIg very well. Any side effects you may experience are usually mild and settle quickly, especially as your body gets used to treatment.

Common, mild side effects

These usually happen around the infusion site and improve within a few hours:

• Redness
• Swelling or puffiness
• Itching
• Tenderness or mild discomfort
• Small lumps under the skin
• Bruising

These are normal and often improve over time or by changing the infusion site.

General symptoms

Some people may feel:

• A mild headache
• Tired
• Slightly achy
• Mildly sick (nausea)
• Chilly or shivery

These usually pass on their own and can often be improved by slowing the infusion rate or adjusting the volume per site.

Less common symptoms

These are less frequent, but some people may notice:

• Dizziness
• A mild rash
• Muscle or joint aches
• A little stomach discomfort

When to seek advice

Serious reactions are rare so please seek urgent help if you experience:

• A severe or worsening headache
• Trouble breathing
• Chest pain
• A widespread rash or hives
• Feeling faint or very dizzy

Are there any alternatives to home therapy?

If you decide home therapy is not suitable for you, or if you prefer not to self-administer your immunoglobulin, there are other options that we can discuss with you to make sure your treatment is as convenient and accessible as possible.

Managing your treatment at home

24‑month assessment

You will need a review every 24 months to make sure you are still administering your treatment safely and correctly. This assessment also gives you the opportunity to talk with the specialist nurses about any issues, concerns, or questions you may have. We will also review your treatment plan during this appointment to ensure it continues to meet your needs.

Follow‑up appointments and blood monitoring

It is important that you attend a face-to-face annual Immunology follow‑up appointments. These reviews help us make sure your treatment is working effectively, and your immunoglobulin levels remain within a safe range.

Around six months after your annual review, you may also be offered a telephone appointment to review and to discuss any questions or concerns.

We also require six monthly blood monitoring. This helps us keep track of your immunoglobulin levels and overall health while you are on treatment. We can discuss the best and most convenient way for you to have these blood tests.

Attending these reviews and having bloods taken helps ensure your treatment stays safe, effective, and tailored to your needs.

Support and advice

If you have any questions or concerns about your treatment, you can contact the Immunology Nurses or the Immunology Secretary using the numbers provided.

Emergency advice

Please note we do not provide 24‑hour or emergency cover.

If you require urgent medical attention, contact your GP, NHS 111, or emergency services.

For your information

Once you are on treatment, your immunoglobulin product may occasionally change due to national NHS England commissioning decisions. These changes happen every two years and are not decided by our department, but we will support you through the process if a change is required.

At times during your treatment, we may discuss pausing or stopping immunoglobulin therapy. This is a routine part of care, as some patients’ immune systems can improve over time. If your immune function recovers, you may no longer need immunoglobulin treatment.

Contacting the Immunology Specialist Nurses

If you need further information or would like to discuss any concerns about your treatment, please contact the Immunology Specialist Nurses using the details below.

Office hours: Monday to Friday, 8am - 4pm (excluding bank holidays)
Immunology Specialist Nurses Telephone: 0161 206 5576
Email: salfordimmunology.nurses@nca.nhs.uk

Other Useful Resources

Northern Care Alliance NHS Foundation Trust
www.northerncarealliance.nhs.uk

Immunodeficiency UK
www.immunodeficiencyuk.org

International Patient Organisation for Primary Immunodeficiencies (IPOPI)
www.ipopi.org.uk

UK Primary Immune-deficiency Patient Support (UKPIPS)
www.ukpips.org.uk