Allergy Asthma Immunol Res.  2011 Apr;3(2):89-95. 10.4168/aair.2011.3.2.89.

Long-term Efficacy of Intravenous Immunoglobulin Therapy for Moderate to Severe Childhood Atopic Dermatitis

• Jee SJ
• Kim JH
• Baek HS
• Lee HB
• Oh JW

• KMID: 2130359
• DOI: http://doi.org/10.4168/aair.2011.3.2.89

Abstract

PURPOSE
The present study investigates the long-term effects of intravenous immunoglobulin (IVIg) therapy for the treatment of moderate to severe childhood atopic dermatitis (AD). Previous research indicates that IVIg can treat severe AD; however, the effectiveness of IVIg has not been confirmed in prospective, blinded clinical trials.
METHODS
Forty eligible children with moderate to severe AD, as defined by the criteria of Hanifin and Rajka, were enrolled in a randomized, placebo-controlled study. After the completion of an initial screening visit (V0), the patients were randomly allocated into therapy (n=30) and control (n=10) groups (V1). Thirty children were each treated with three injections of 2.0 g/kg IVIg at 1-month intervals over a 12-week period. Ten children were treated with placebo. Assessments were conducted after each injection (V2, V3, and V4) and at 3 (V5) and 6 months (V6) after completed treatment.
RESULTS
The disease severity index was significantly decreased at V5 compared with the value at V1 (P<0.05). There were no significant changes in the total IgE level or total eosinophil count in peripheral blood at the last injection (V4) compared with the value at V1. The interleukin (IL)-5/interferon (IFN)-gamma ratio was assessed in T-helper 1 (Th1) and Th2 cells. The ratio significantly decreased between V1 and V5, after which it increased, such that the ratio at V6 was not significantly different from that at V1. Compared with the level at V1, the intercellular cell adhesion molecule-1 level at V4 did not differ significantly, but the level at V5 was lower.
CONCLUSIONS
This study suggests that IVIg therapy may clinically improve AD in patients after 3 months of therapy, but the improvement may decline by 6 months after therapy.

Keyword

Intravenous immunoglobulin; atopic dermatitis

MeSH Terms

Cell Adhesion
Child
Dermatitis, Atopic
Eosinophils
Humans
Immunization, Passive
Immunoglobulin E
Immunoglobulins
Immunoglobulins, Intravenous
Interleukins
Mass Screening
Prospective Studies
Th2 Cells
Immunoglobulin E
Immunoglobulins
Immunoglobulins, Intravenous
Interleukins

Figure

• 

  Fig. 1 Study design of intravenous immunoglobulin (IVIg) therapy, blood specimen collection for laboratory analyses, and evaluation of clinical efficacy. *Immunoglobulin IV injection: three times (2 g/kg month IV) for 12 weeks; †Follow up: after completing injection, every 4 weeks for 6 months.

• 

  Fig. 2 SCORAD index before (V1) and during therapy (V4), and at 3 (V5) and 6 months (V6) after the last intravenous immunoglobulin (IVIg) injection. The SCORAD index was significantly lower at the 3-month follow-up visit (V5) compared with the index at V1, but it had increased by the 6-month follow-up visit (V6).

• 

  Fig. 3 Total body surface area of lesions (A) and subjective symptoms score (B) before (V1) and during therapy (V4), and at 3 (V5) and 6 months (V6) after the last IVIg injection. The total body surface area of lesions was significantly lower at the 3-month follow-up visit (V5) compared with the area at V1, but it had increased by the 6-month follow-up visit (V6). The subjective symptoms score did not change significantly.

• 

  Fig. 4 The serum IgE concentration (A) and total eosinophil count (B) before (V1) and during therapy (V4), and at 3 (V5) and 6 months (V6) after the last IVIg injection. These parameters did not change significantly.

• 

  Fig. 5 Eosinophil cationic protein (ECP) concentration before (V1) and during therapy (V4), and at 3 (V5) and 6 months (V6) after the last IVIg injection. The ECP concentration was significantly lower (P < 0.05) at the 3-month follow-up visit (V5) compared with the concentration at V1, but it had increased significantly by the 6-month follow-up visit (V6).

• 

  Fig. 6 The IL-5 (A) and IFN-γ (B) concentrations before (V1) and during therapy (V4), and at 3 (V5) and 6 months (V6) after the last intravenous immunoglobulin (IVIg) injection. The IL-5 level was significantly lower (P<0.05) at the 3-month follow-up visit (V5) compared with the level at V1, but it had increased by the 6-month follow-up visit (V6). The IFN-γ level did not change significantly.

• 

  Fig. 7 The IL-5/IFN-γ ratio before (V1) and during therapy (V4), and at 3 (V5) and 6 months (V6) after the last intravenous immunoglobulin (IVIg) injection. The IL-5/IFN-γ ratio was significantly lower at the 3-month follow-up visit (V5) compared with the ratio at V1, but it had increased by the 6-month follow-up visit (V6).

• 

  Fig. 8 Intracellular cell adhesion molecule (ICAM)-1 concentration before (V1) and during therapy (V4), and at 3 (V5) and 6 months (V6) after the last IVIg injection. The ICAM-1 concentration was significantly lower at the 3-month follow-up visit (V5) compared with the concentration at V1, but it had increased by the 6-month follow-up visit (V6).

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