Abstract
Intravenous immunoglobulin (IVIG) has become an accepted mode of therapy in immune diseases with the potential to act as an immune enhancer or immunomodulator. A 14-year-old girl with severe steroid-dependent asthma was enrolled in a trial of high dose intravenous immunoglobulin because of the unremitting nature of her illness and severe steroid side effects. She received 2 g/kg of IVIG every month for six months. In the 4 months preceding IVIG therapy she had repeated exacerbations of her asthma. In contrast, during the 6 months of IVIG therapy, she only had one exacerbation of her asthma. Her steroid dose was tapered by 75% and her FEV 1 improved by 100%. To detect alterations in immune reactivity, we monitored serial skin tests to an individualized panel of antigens, RAST tests to the same panel, and specific IgG levels. Serial titrations of her prick skin tests showed a 2–3 log increase in threshold for skin reactivity to all five antigens on her panel. In parallel, RAST results to the same antigen panel showed a decrease in specific IgE production. The significant clinical improvement and steroid reduction in this patient appear due, at least in part, to the immunomodulatory effects of high dose IVIG therapy.
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