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Intravenous Immunoglobulin to Treat Severe Atopic Dermatitis in Children: A Case Series

Authors

  • Paul J. Turner F.R.A.C.P., Ph.D.,

    1. Department of Allergy and Immunology, Children’s Hospital at Westmead
    2. Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney
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  • Alyson Kakakios F.R.A.C.P.,

    1. Department of Allergy and Immunology, Children’s Hospital at Westmead
    2. Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney
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  • Li-Chuen Wong F.R.A.C.P.,

    1. Department of Dermatology, Children’s Hospital at Westmead, Sydney, Australia
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  • Melanie Wong F.R.A.C.P., F.R.C.P.A., Ph.D.,

    1. Department of Allergy and Immunology, Children’s Hospital at Westmead
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  • Dianne E. Campbell F.R.A.C.P., Ph.D.

    1. Department of Allergy and Immunology, Children’s Hospital at Westmead
    2. Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney
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Address correspondence to Paul Turner, F.R.A.C.P., Ph.D., Department of Allergy and Immunology, Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia, or e-mail: paulyt@doctors.org.uk.

Abstract

Abstract:  Severe cases of atopic dermatitis (AD) may require systemic immunosuppression to achieve disease control. Unfortunately, some cases continue to be refractory to management or develop unacceptable adverse effects. There are limited reports of the use of intravenous immunoglobulin (IVIg) in the treatment of severe AD, but results are inconsistent. In a retrospective study, we report 10 children with severe AD refractory to systemic immunosuppression and maximal topical therapy who were treated using IVIg. The children received monthly IVIg for an average of 24 months. This resulted in a significant improvement in symptoms, with fewer infection-related exacerbations and hospitalizations, allowing systemic immunosuppression to be tapered. The effect was associated with a significant decrease in serum immunoglobulin E and was sustained after cessation of IVIg in 50% of cases. No significant side effects attributable to the IVIg infusions were noted. In this cohort of children with severe AD and recurrent cutaneous infections, IVIg provided an effective treatment with minimal side effects and significant benefits in school attendance and quality of life.

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