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sequence matters

Before IVIG

Families often reach for IVIG after everything else has failed. Sometimes it is exactly right. But when it fails, the reason is often something that was findable in advance.

Why sequence matters

IVIG modulates the immune system. It does not remove an ongoing infection, a mold exposure, or a strep carrier in the household. If a driver is still actively feeding the fire, IVIG is working against a running tap.

The most common reason IVIG "fails" is not that it was the wrong treatment. It is that it was given while an untreated driver was still active.

What to finish first

  1. A complete infection workup — strep titers, full Mycoplasma (IgG, IgM and PCR), tick-borne panel including Bartonella and Babesia, relevant viral serologies.
  2. A full immune workup — immunoglobulins, IgG subclasses, pneumococcal titers. This does double duty: it can reveal a deficiency and, if positive, it documents medical necessity, which is often what gets IVIG covered.
  3. Environmental — mold and the away trial. You cannot immune-modulate a child out of a moldy house.
  4. Household reservoirs — strep carriers, tonsils, sinuses.
  5. The obvious modifiables — sleep, bowels, hydration, and any supplement that may be making things worse.

The upside of doing it in this order

Two good outcomes. Sometimes treating the drivers means IVIG is no longer needed. And when it is still needed, it works against a much quieter background — and you have the documentation to get it approved.

None of this is an argument against IVIG

For the right child it can be genuinely transformative, and delay has its own cost. This is an argument for finishing the workup while you wait — not for waiting instead of treating.

Want this answered for your own child? A Plan B synthesis reads every lab and note you have — together — and tells you what is driving the picture, what has never been checked, and what to ask for next.

The first one is free, and you keep the list either way. Phone photos of labs are fine.

Start a free synthesis
Keep reading
The immune workup almost nobody orders
Immunoglobulins, IgG subclasses and pneumococcal titers — the standard, covered blood tests that explain why some children cannot stop getting reinfected.
It is almost never one thing
In our cohort, 53% of children carried three or more infection or mold drivers at once. Why treating one thing at a time keeps failing.
Find the one biggest driver first
Why treating a PANS child one symptom at a time keeps failing, and how to identify the single driver worth going after before anything else.

Plan B for PANS is written by a parent, not a physician. Nothing here is medical advice or a substitute for your child's clinicians — it is meant to make you the best-informed person in the room when you talk to them.