High-dose intravenous immunoglobulin for severe drug reactions: efficacy in toxic epidermal necrolysis.
High-dose intravenous immunoglobulin has been proposed as an alternative treatment for several immuno-mediated inflammatory skin diseases, usually at a dosage of 1 - 2 g/kg. We describe the treatment of 10 patients affected by toxic epidermal necrolysis using 400 mg/kg per day on 5 consecutive days--a schedule that is lower than previously reported schedules. According to the SCORTEN, the earlier predicted mortality rate was 35%. After high-dose intravenous immunoglobulin therapy, a mortality rate of 10% and a survival rate of 90% were reached. In particular, nine patients showed a dramatic improvement already after one course of infusion started at an early stage of the disease. It is our experience, and that of others, that high-dose intravenous immunoglobulin can be considered the drug of first choice for toxic epidermal necrolysis, one of the most severe life-threatening dermatological conditions, and a valid alternative therapy for different long-standing chronic dermatological diseases. This therapy can also be effective in avoiding high steroid dosages and consequently steroid-related or immunosuppressive-related side effects. It is therefore reasonable to propose high-dose intravenous immunoglobulin treatment as a valuable therapeutic tool for dermatologists.
Campione
Elena
E
Department of Dermatology, Tor Vergata University of Rome, Policlinico di Tor Vergata, Rome, Italy.
Marulli
Georgiana Clare
GC
Carrozzo
Anna Maria
AM
Chimenti
Maria Sole
MS
Costanzo
Antonio
A
Bianchi
Luca
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004305:Dose-Response Relationship, Drug; D004342:Drug Hypersensitivity / Q000150:complications*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous