EDITOR,—R A C Hughes emphasises that, on the basis of the results of recent randomised studies, intravenous immunoglobulin is as efficacious as plasmapheresis in the treatment of the Guillain-Barre syndrome.1 In view of the practical difficulties associated with plasmapheresis, intravenous immunoglobulin is increasingly likely to be preferred as first line treatment.

In this context Hughes states that intravenous immunoglobulin should be avoided in patients with IgA deficiency. This may mislead clinicians who are unfamiliar with immunoglobulin treatment and may result …