Wakim M, Alazard M, Yajima A, Speights D, Saxon A, Stiehm E R
Department of Pediatrics, UCLA School of Medicine, Los Angeles, California 90095-1752, USA.
Ann Allergy Asthma Immunol. 1998 Aug;81(2):153-8. doi: 10.1016/S1081-1206(10)62802-5.
High dose intravenous immunoglobulin (IVIG) has immunoregulatory and anti-inflammatory properties that might benefit illnesses with exaggerated IgE responses including atopic dermatitis and hyper-IgE immunodeficiency syndrome.
To determine if high-dose IVIG would be of benefit to patients with severe atopic dermatitis and/or hyper-IgE syndrome using serial clinical, pulmonary, and laboratory studies for evaluation.
This was an open label study in which we gave patients with hyper-IgE syndrome (n = 1) or severe atopic dermatitis (n = 9) IVIG as a 10% solution (Venoglobulin I-Alpha Therapeutic Corporation, Los Angeles, CA) at a dose of 2 g/kg every 30 days for seven infusions.
Therapy was completed in nine of the ten patients. Skin disease improved slightly in six patients, remained unchanged in two patients, and worsened slightly in one patient. The average daily prednisone dosage was 6.8 mg/day prior to treatment and 5.1 mg/day during IVIG therapy (P = .1250). The three patients with abnormal pulmonary function showed very mild improvement of pulmonary function during treatment, but returned to baseline during follow-up. Flow cytometric studies showed no consistent pattern of change. IgA and IgM levels were unchanged. The mean serum IgE levels went from 3221+/-2454 IU/mL (SD) before IVIG to 2944+/-2491 IU/mL (P = .4609) during IVIG and then to 2321+/-2229 IU/mL (P = .1484) during the 6-month follow-up period. In vitro IgE production of peripheral blood mononuclear cells (PBMC) following IL-4 and anti-CD40 stimulation before IVIG was 6.6+/-3.1 ng/mL (SD) and 4.3+/-3.1 ng/mL (P = .1641) after six IVIG treatments. There were no significant trends in lymphocyte proliferative responses to PHA (phytohemaglutinin), Candida, tetanus, and anti-CD3 monoclonal antibody. Radioallergosorbent (RAST) testing showed no clear changes from positivity to negativity.
We conclude that IVIG was of no clear clinical benefit in these nine patients and did not significantly decrease IgE levels, IgE synthesis, or other measures of immunologic function.
高剂量静脉注射免疫球蛋白（IVIG）具有免疫调节和抗炎特性，可能对包括特应性皮炎和高IgE免疫缺陷综合征在内的IgE反应过度的疾病有益。
通过系列临床、肺部和实验室研究进行评估，以确定高剂量IVIG对重度特应性皮炎和/或高IgE综合征患者是否有益。
这是一项开放标签研究，我们给予高IgE综合征患者（n = 1）或重度特应性皮炎患者（n = 9）10%溶液的IVIG（Venoglobulin I - Alpha Therapeutic Corporation，洛杉矶，加利福尼亚州），剂量为每30天2 g/kg，共输注7次。
10名患者中有9名完成了治疗。6名患者的皮肤病稍有改善，2名患者保持不变，1名患者稍有恶化。治疗前泼尼松平均每日剂量为6.8 mg/天，IVIG治疗期间为5.1 mg/天（P = 0.1250）。3名肺功能异常的患者在治疗期间肺功能有非常轻微的改善，但在随访期间恢复到基线水平。流式细胞术研究显示没有一致的变化模式。IgA和IgM水平未改变。血清IgE平均水平从IVIG治疗前的3221±2454 IU/mL（标准差）降至IVIG治疗期间的2944±2491 IU/mL（P = 0.4609），然后在6个月随访期降至2321±2229 IU/mL（P = 0.1484）。IVIG治疗前，白细胞介素-4和抗CD40刺激后外周血单个核细胞（PBMC）的体外IgE产生为6.6±3.1 ng/mL（标准差），6次IVIG治疗后为4.3±3.1 ng/mL（P = 0.1641）。对植物血凝素（PHA）、念珠菌、破伤风和抗CD3单克隆抗体的淋巴细胞增殖反应没有显著趋势。放射变应原吸附（RAST）试验显示从阳性到阴性没有明显变化。
我们得出结论，IVIG对这9名患者没有明显的临床益处，也没有显著降低IgE水平、IgE合成或其他免疫功能指标。
