Effect of intravenous immunoglobulin on steroid consumption in patients with severe asthma: A double-blind, placebo-controlled, randomized trial

Salmun, Luis M.; Barlan, Işıl; Wolf, Hermann M.; Eibl, Martha M.; Twarog, Frank J.; Geha, Raif S.; Schneider, Lynda C.

doi:10.1016/s0091-6749(99)70424-0

Cited by 69 publications

(29 citation statements)

References 33 publications

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“…IgG, were studied as corticosteroid-sparing agents with the aim of reducing the dose of maintenance OCS. Although these agents may be considered to improve corticosteroid insensitivity, their efficacy is uncertain, and they are associated with significant side-effects (see GRADE question below) [179][180][181][182][183].…”

Section: Using Established Asthma Medications Corticosteroid Insensitmentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations.When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled” despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided.Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.

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Section: Using Established Asthma Medications Corticosteroid Insensitmentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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“…However, other effects of the long-term use of macrolides in asthma remain under study [134]. The use of intravenous Ig is not recommended [135][136][137].…”

Section: Oral Anti-allergic Compoundsmentioning

confidence: 99%

Global strategy for asthma management and prevention: GINA executive summary

Bateman

Ss²,

Barnes³

et al. 2008

European Respiratory Journal

2,641

2,301

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Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled ''A Global Strategy for Asthma Management and Prevention'', first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that ''it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained,'' and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.

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“…As the clinical syndromes in IgA deficiency are likely to be related to impaired IgA-dependent protection at mucosal surfaces, it is conceivable that in asthmatics without detectable IgA (or other) immunodeficiency, subtle changes in the mucosal immune protection could underlie the pathogenesis of the disease. Therefore, it may not be surprising that supplemental intravenous immunoglobulin therapy even in normogammaglobulinemic severe asthmatics has been reported to decrease symptoms, hospitalization and steroid use [9, 10]. However, there are also studies reporting no significant effect of intravenous immunoglobulin therapy [11,12,13].…”

Section: Introductionmentioning

confidence: 99%

Subtle Immunodeficiency in Severe Asthma: IgA and IgG<sub>2</sub> Correlate with Lung Function and Symptoms

Balzar¹,

Strand²,

Nakano³

et al. 2006

Int Arch Allergy Immunol

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Background: Atopy, increased serum IgE and eosinophilic airway inflammation are common in asthma and may indicate aberrant immune responses, but the cause(s) are unknown. It was hypothesized that differences in serum immunoglobulins, immunoglobulin free light chains (FLC) and secretory IgA (sIgA) would exist between subjects with asthma of varying severity and normal subjects, and the levels would correlate with lung function, symptoms and airway inflammation. Methods: Serum IgG, IgA, IgE and IgM, IgG subclasses and FLC, and bronchoalveolar lavage sIgA were evaluated from 15 normal subjects, 9 mild and 22 severe asthmatics with similar atopic status. Asthma symptoms were obtained by questionnaire, and airway inflammation was assessed by immunostaining for five inflammatory cell types. Results: Immunoglobulin levels in all groups were generally within the normal range. However, IgA and IgG were lower in severe asthmatics than normal subjects (overall p = 0.006 and 0.02, respectively). IgA, but not IgG, correlated with lung function and asthma symptoms (r-values >0.58; p-values <0.009). Although similar among the groups, higher sIgA and IgG₂ also positively correlated with lung function and negatively with asthma symptoms (r-values >0.63; p-values <0.009). IgA and IgG/IgG₁ positively correlated with tissue mast cells. Conclusions: Subtle alterations in IgA- and IgG₂-mediated responses in asthma may be disease-related. As their levels are generally normal, it is possible that the quality/repertoire of immune protection provided by these isotypes, perhaps against carbohydrate epitopes, may be altered in asthma.

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Effect of intravenous immunoglobulin on steroid consumption in patients with severe asthma: A double-blind, placebo-controlled, randomized trial

Cited by 69 publications

References 33 publications

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

Global strategy for asthma management and prevention: GINA executive summary

Subtle Immunodeficiency in Severe Asthma: IgA and IgG<sub>2</sub> Correlate with Lung Function and Symptoms

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