Loza Cortina C
Hospital de Jarrio, Pediatric Service, Unit of Allergy, Jarrio, Asturias, 33719, España.
Allergol Immunopathol (Madr). 1999 May-Jun;27(3):165-7.
Patients with severe asthma pose a dilemma to the physician since the treatment they need, namely high doses of oral steroids, has serious side effects, especially among the pediatric population. Deficiency in one or more of the IgG subclasses has been associated with abnormal pulmonary function, as well as with recurrent sinopulmonary infections in adults and children. In the last years attention has been focused on alternative therapies for these patients. One of these alternatives is the treatment with intravenous immunoglobulin (IVIG). We report an 11-year-old boy with severe asthma since the age of two years and multiple hospital admissions due to asthmatic crisis even more frequent and severe, to the point of needing, in the last year, daily treatment with high doses of oral steroids (20 mg). During six months the patient was given high doses of intravenous immunoglobulin. After one month of treatment a clinical and spirometric improvement was apparent allowing to taper down the oral steroids until their complete substitution by inhaled budesonide (1,600 microg/day). The only side effects noted were severe headaches after gammaglobulin infusions which responded well to oral paracetamol. This improvement was sustained throughout the treatment period, but few weeks after the IVIG was suspended the clinical and spirometric parameters started to worsen again.
重度哮喘患者给医生带来了两难困境，因为他们所需的治疗，即高剂量口服类固醇，有严重的副作用，尤其是在儿童群体中。一种或多种IgG亚类的缺乏与肺功能异常以及成人和儿童反复发生的鼻窦肺部感染有关。近年来，注意力集中在这些患者的替代疗法上。其中一种替代方法是静脉注射免疫球蛋白（IVIG）治疗。我们报告一名11岁男孩，自两岁起患有重度哮喘，因哮喘发作多次住院，发作愈发频繁和严重，以至于在去年需要每日使用高剂量口服类固醇（20毫克）治疗。在六个月的时间里，该患者接受了高剂量静脉注射免疫球蛋白治疗。治疗一个月后，临床和肺功能测量结果明显改善，使得口服类固醇剂量逐渐减少，直至完全被吸入布地奈德（1600微克/天）替代。唯一观察到的副作用是输注丙种球蛋白后出现严重头痛，口服扑热息痛后反应良好。这种改善在整个治疗期间持续存在，但在停用IVIG几周后，临床和肺功能测量参数又开始恶化。
