Supportive gamma-globulin therapy in refractory chronic respiratory tract infections

Abstract

The efficacy of a gamma-globulin preparation given as a supportive therapy was examined inrefractory chronic respiratory tract infection (RTI) causing expectoration oflarge amounts of purulentsputa and repeating acute aggravations.In human i.v. doses of the pepsin-treated gamma-globulin preparation gave considerably fluctuatingconcentrations in the blood and sputum, but those concentrations reached their peaks at 3-5 hours. Witha dose of 5g, peak sputum levels ranged from 10 to 80mg/dl, showing good penetration of contained gamma-globulins into the sputum.Reactions of contained gamma-globulins with bacteria were confirmed in vitro by the latexagglutination method and the immunofluorescence method. The immunofluorescence method alsodemonstrated that bacteria coated with gamma-globulins underwent phagocytosisof human neutrophils. In addition, immunofluorescent examinations of sputa from patinets with chronic RTI demonstrated thatnegative cases turned positive soon after gamma-globulin treatment, revealingthat the gamma-globulinstransferred into the sputum promptly reacted with bacteria existing there.On the basis of the above results, we examined the efficacy of the gamma-globulin preparationadministered at 1-2 weeks' intervals over a long period in refractory, chronic RTI causing expectorationlarge amounts of purulent sputa and repeating acute aggravations. The efficacy of the gamma-globulinpreparation was excellent or good in 3 of 6 patients.