Abstract: The European Society for Immunodeficiencies (ESID) Primary Immunodeficiencies Care in Development Working Party was founded in order to improve diagnosis and care of patients with primary immunodeficiencies (PIDs). Immunoglobulins (Ig) are used as a replacement therapy in PIDs associated with deficiencies of antibody production 1. The Working Party initiated a pan-European survey on the use and availability of Ig preparations in European countries for treatment of PIDs, which resulted in the Europe Immunoglobulin Map. In each European country, one contact person was appointed to answer the survey questionnaire. Work on the map was initiated in 2006, and since 2011 a regular survey has reflected the development in Ig usage all over Europe. To date, we have information from 35 European countries. The survey brings a unique and interesting view regarding Ig treatment for PIDs in individual European countries, and further shows the trends and changes in this area. Since 2012 the use of Ig treatment has increased, mainly in eastern European countries. Intravenous immunoglobulin (IVIg) products are available in all European countries, even if the spectrum of available preparations and the access of PID patients to IVIg therapy might differ. Some countries show limited availability in the spectrum of Ig preparations and some, mainly for economic reasons, are not able to comply with recommended dosing protocols. Four countries report that they offer hospital and home-based IVIg treatment. Subcutaneous immunoglobulin (SCIg) products are increasing in availability and usage, with access spreading from North West Europe to South East Europe, such that in 2014 there are only a very few European countries without SCIg (Fig. 1). Subcutaneous immunoglobulin (SCIg) use in Europe, 2014. Inset shows SCIg use in 2011 and 2013, respectively. SCIg therapy is used most often in paediatric PID populations (Fig. 2). In some countries, such as the United Kingdom, Belgium, Norway and Sweden, SCIg therapy dominates among children, as well as the fact that SCIg therapy is given most often as self-/parent-managed treatment at home, in turn increasing the children's and the families' quality of life 2. SCIg preparations are usually given by pump, but the rapid-push technique is also being used more widely. Approximate ratio of intravenous immunoglobulin and subcutaneous immunoglobulin (IVIg : SCIg) in the treatment of adults and children with primary immunodeficiencies (PIDs) in Europe, 2014. The first number for each country shows the percentage of patients on IVIg treatment, the second number the percentage on SCIg treatment. In the majority of countries, the main problem relating to access to proper treatment was highlighted as being the continuing problem of lack of awareness of PID symptoms and thereby subsequent under-diagnosis, especially in adults. However, once a PID diagnosis is suspected, most patients are referred to special diagnostic and care centres. Nevertheless, a few countries point to a problem of smaller clinics 'holding on' to patients, instead of referring them to expert centres. A few countries were concerned that the cost of Ig preparations was one reason for not being able to give the internationally recommended dosages 3 or to treat all patients in need of Ig therapy. However, the funding of Ig therapy differs between countries; about half of countries have some form of national/governmental reimbursement system, while other countries must find individual solutions for the patients. The pan-European survey has been shown to be a very useful and interesting tool to map, harmonize and facilitate the availability of Ig products and the care of PID patients. Continuing mapping might help to identify the countries in need of help for accessing Ig products, which is very important as these products are essential therapies for PIDs 3, both as lifelong replacement therapy for children, adults and elderly people with primary antibody failure, but also transiently in patients with severe combined immunodeficiencies, before and after undergoing human stem cell transplantation. A. S., H. C., and A. G. would like to thank all contributors for sharing their centres' data with the European Immunoglobulin Map Group: Hermann Wolf (Austria), Elisabeth Förster-Waldl (Austria), Michail Belevtsev (Belarus), Isabelle Meyts (Belgium), Velma Mulaosmanović (Bosnia Herzegovina), Elisaveta Naumova (Bulgaria), Jadranka Kelecic (Croatia), Jiří Litzman (Czech Republic), Carsten Heilmann (Denmark), Sirje Velbri (Estonia), Mikko Seppänen (Finland), Eric Oksenhendler (France), Klaus Warnatz (Germany), Maria Kanariou (Greece), László Maródi (Hungary), Björn R. Lúdvíksson (Iceland), Mary Keogan (Ireland), Isabella Quinti (Italy), Tatjana Prokofjeva (Latvia), Rasa Duobiene (Lithuania), François Hentges (Luxembourg), Kristina Mironska (Macedonia), Esther de Vries (The Netherlands), Borre Fevang (Norway), Malgorzata Pac (Poland), Danuta Kowalczyk (Poland), Susana Lopes da Silva (Portugal), Mihaela Bataneant (Romania), Cochino Alexis (Romania), Anna Shcherbina (Russia), Irina Tuzankina (Russia), Dragana Koruga (Serbia), Peter Ciznar (Slovakia), Tadej Avcin (Slovenia), Teresa Español (Spain), Ann Gardulf (Sweden), Miriam Hoernes (Switzerland), Helen Chapel (UK) and Ismail Reisli (Turkey). A. S. has received consultancy fees from CSL Behring, Baxter and Octapharma. H. C. has received consultancy fees from Biotest, Baxter and LFB. A. G. has collaborated with CSL Behring, Baxter and Octapharma for advisory boards, but received no direct funding.