title: The relationship of eosinophilia to intravenous immunoglobulin treatment failure in Kawasaki disease.
abstract: To investigate the role of eosinophils in Kawasaki disease (KD) and the relationship to initial intravenous immunoglobulin (IVIG) treatment failure. A retrospective analysis of all children who were admitted and met the criteria of KD between 1999 and 2005. The patients were divided into IVIG-responsive and IVIG-resistant groups. A total of 185 patients were enrolled during the study period. A series of blood eosinophils and biochemistry studies were correlated to the effectiveness of IVIG. The neutrophils percentage before IVIG treatment (pre-IVIG), leukocyte counts within 3 days after IVIG treatment (post-IVIG), liver enzyme, albumin levels, and post-IVIG eosinophils percentage were all significantly different between the two groups in univariate analysis. Under multivariate analysis with logistic regression, post-IVIG eosinophilia [peripheral blood (PB) eosinophils >or=4%] had an inverse correlation to KD patients with IVIG-resistance (p = 0.003). Also, pre-IVIG hypoalbuminemia (albumin <or=3.0 g/dl) was positively correlated to IVIG-resistance (p = 0.018). Further analysis showed that the PB eosinophils was markedly increased in the acute stage and returned to normal 3 weeks after IVIG treatment (p < 0.001). Eosinophil levels are highly elevated in the acute stage of KD both before and after the IVIG treatment. Post-IVIG treatment eosinophilia has an inverse correlation to KD patients with IVIG-resistance and may indicate IVIG-responsive. This may be a valuable factor to survey for the necessity of a second dose IVIG treatment.
authors.affiliation: Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
authors.forename: Ho-Chang
authors.initials: HC
authors.lastname: Kuo
authors.forename: Kuender D
authors.initials: KD
authors.lastname: Yang
authors.forename: Chi-Di
authors.initials: CD
authors.lastname: Liang
authors.forename: Chin-Nam
authors.initials: CN
authors.lastname: Bong
authors.forename: Hong-Ren
authors.initials: HR
authors.lastname: Yu
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.forename: Chih-Lu
authors.initials: CL
authors.lastname: Wang
mesh_terms: D002648:Child; D004802:Eosinophilia / Q000150:complications*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000188:drug therapy*; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D016756:Immunoglobulins, Intravenous