Intravenous gamma-globulin therapy in bronchial asthma

Two possible uses exist for intravenous gamma-globulin (IVIG) therapy in asthma. First, it has been suggested that high-dose IVIG can serve as an anti-inflammatory, immunomodulatory agent in steroid-dependent asthma patients. Second, IVIG can be used as a replacement treatment in those asthma patients with frank hypogammaglobulinemia or more subtle antibody deficiencies. The mechanisms by which IVIG functions are widely different in these two potential uses. Clear characterization of the patients' immune status is pivotal in choosing whether to use IVIG. The assessment should not be limited to simple determination of serum immunoglobulin A (IgA), IgG, IgM, and IgG subclass levels. When clinically warranted, the specific antibody response to active immunization with antigens such as those in Pneumovax may be invaluable in identifying patients with subtle antibody-deficiency disorders. Asthma in those patients may be improved markedly if infection is prevented by antibody-replacement therapy with IVIG.