title: Adjunctive high-dose intravenous immunoglobulin treatment for resistant atopic dermatitis: efficacy and effects on intracellular cytokine levels and CD4 counts.
abstract: Although atopic dermatitis generally responds to topical therapy, small numbers of patients have severe resistant disease despite second-line therapies. High-dose intravenous immunoglobulin has been suggested to be of benefit in a small number of reports. We have conducted an open, single-centre study of adjunctive high-dose intravenous immunoglobulin (Flebogamma 5%). Six patients received treatment at 2 g kg(-1) month(-1) for 6 cycles, with a 3-month follow-up period. Skin scores, lymphocyte phenotypes and intracellular cytokine analysis were performed. Four of six patients had major improvements in skin scores and the overall reduction was significant (p = 0.035). CD4+ T-cell numbers fell following high-dose intravenous immunoglobulin infusions, recovering by the next cycle. T-cell CD69 expression decreased to 60% of baseline values. Reductions in the proinflammatory cytokines IFN-gamma and TNF-alpha were non-significant. Adjunctive high-dose intravenous immunoglobulin may be a useful therapeutic approach in adults with severe treatment-resistant atopic dermatitis, but it will require further assessment in randomized controlled trials to establish this.
authors.affiliation: National Institute for Medical Research, Division of Infection and Immunity, The Ridgeway, Mill Hill, London, UK. sjolles@nimr.mrc.ac.uk
authors.forename: Stephen
authors.initials: S
authors.lastname: Jolles
authors.forename: Carrock
authors.initials: C
authors.lastname: Sewell
authors.forename: David
authors.initials: D
authors.lastname: Webster
authors.forename: Annie
authors.initials: A
authors.lastname: Ryan
authors.forename: Bridget
authors.initials: B
authors.lastname: Heelan
authors.forename: Annie
authors.initials: A
authors.lastname: Waite
authors.forename: Malcolm
authors.initials: M
authors.lastname: Rustin
mesh_terms: D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D016207:Cytokines / Q000032:analysis / Q000187:drug effects*; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D016207:Cytokines; D016756:Immunoglobulins, Intravenous