title: Immunoglobulin Resistance in Kawasaki Disease.
abstract: Background:The aim of this study was to identify risk factors for immunoglobulin resistance, including clinical symptoms such as arthritis and the pH of intravenous immunoglobulin.Methods:The data of children with Kawasaki disease who had received immunoglobulin were evaluated. Data regarding the brand of immunoglobulin administered were abstracted from the pharmacy records.Results:Eighty consecutive children with Kawasaki disease were evaluated (Mdnage=28 months, 66% male). The prevalence of immunoglobulin resistance was 30%. Arthritis was a presenting symptom in the acute phase of Kawasaki disease in 8% (6/80, all male) and was seen in significant association with immunoglobulin resistance in comparison to those without arthritis (16.7% vs. 0.2%,p=0.008). Next, the immunoglobulin brand types were divided into two groups: the relatively high pH group (n=16), including Carimune (pH 6.6±0.2), and the low pH group (n=63), including Gamunex (pH 4-4.5) or Privigen (pH 4.6-5). Overall, no significant difference in immunoglobulin responsiveness was found between the low pH and the high pH groups (73% vs. 56%,p=0.193), although the low pH group showed a trend toward a larger decrease in erythrocyte sedimentation rate (p=0.048), lower steroid use (p=0.054), and lower coronary involvement (p=0.08) than those in the high pH group.Conclusions:Children presenting with arthritis in the acute phase of Kawasaki disease may be at risk for immunoglobulin resistance.
authors: Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School , Houston, Texas.
authors: Georgios A
authors: GA
authors: Hartas
authors: Pediatric Research Center, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School , Houston, Texas.
authors: Syed Shahrukh
authors: SS
authors: Hashmi
authors: Department of Pharmacy, Children's Memorial Hermann Hospital, The University of Texas Medical School , Houston, Texas.
authors: Chi
authors: C
authors: Pham-Peyton
authors: Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School , Houston, Texas.
authors: Emmanouil
authors: E
authors: Tsounias
authors: Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School , Houston, Texas.
authors: John T
authors: JT
authors: Bricker
authors: Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School , Houston, Texas.
authors: Monesha
authors: M
authors: Gupta-Malhotra