Adjunctive High-dose Intravenous Immunoglobulin Treatment for Resistant Atopic Dermatitis: Efficacy and Effects on Intracellular Cytokine Levels and CD4 Counts

Abstract

Although atopic dermatitis generally responds to topical therapy, small numbers of patients have severe resistant disease despite second-line therapies. High-dose intravenous immunoglobulin has been suggested to be of benefit in a small number of reports. We have conducted an open, single-centre study of adjunctive high-dose intravenous immunoglobulin (Flebogamma 5%). Six patients received treatment at 2 g kg(-1) month(-1) for 6 cycles, with a 3-month follow-up period. Skin scores, lymphocyte phenotypes and intracellular cytokine analysis were performed. Four of six patients had major improvements in skin scores and the overall reduction was significant (p = 0.035). CD4+ T-cell numbers fell following high-dose intravenous immunoglobulin infusions, recovering by the next cycle. T-cell CD69 expression decreased to 60% of baseline values. Reductions in the proinflammatory cytokines IFN-gamma and TNF-alpha were non-significant. Adjunctive high-dose intravenous immunoglobulin may be a useful therapeutic approach in adults with severe treatment-resistant atopic dermatitis, but it will require further assessment in randomized controlled trials to establish this.

Off-label uses of biologics in dermatology: Interferon and intravenous immunoglobulin (Part 1 of 2)

“…[368][369][370][371][372][373][374] Additional studies conducted by Noh et al 375,376 are not discussed as patients received very low doses of IVIG. Paul et al 368 conducted the only controlled study.…”

Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

“…Efficacy was also demonstrated at 3 months based on SCORAD and immunologic markers but not at 6 months. Data from smaller studies [70,73] suggests that in select patients with severe, steroid-resistant AD, IVIG may be efficacious. No randomized, controlled trials have been performed, and caution with respect to the infusion frequency, side effects, and cost are additional considerations in the application of IVIG in pediatric atopic dermatitis.…”

Use of IGIV in the treatment of atopic dermatitis, urticaria, scleromyxedema, pyoderma gangrenosum, psoriasis, and pretibial myxedema

“…As yet, no double blind, placebo controlled studies have been performed. There are now 10 children and 30 adults in the literature with AD who have been treated with hdIGIV, 17 of these had adjunctive hdIGIV [13]. A further study using variable lower dose IGIV with short follow-up is not included in this analysis [14].…”

“…High-dose immune globulin intravenous (hdI-GIV) has been noted to be beneficial in the treatment of AD anecdotally, in case reports, and small trials [6][7][8][9][10][11][12][13] ( Table 3). As yet, no double blind, placebo controlled studies have been performed.…”