A review of high-dose intravenous immunoglobulin treatment for atopic dermatitis

Atopic dermatitis generally responds to topical therapy; however, small numbers of patients have severe resistant disease despite second line therapies. High-dose intravenous immunoglobulin (HdIVIg) which is being used increasingly for dermatological indications has been suggested to be of benefit in a small number of uncontrolled trials and case reports. The mode of action is via a number of immunomodulatory mechanisms and it is not associated with the many side-effects of steroids and other immunosuppressive agents. There are now reports of 32 atopic dermatitis patients treated with HdIVIg, and this review aims to make a critical assessment of the current data. These have been obtained from a Medline search of the English literature from 1966 to 2001 for intravenous immunoglobulin and atopic dermatitis/eczema. Taken together an improvement was observed in 61% of atopic dermatitis patients treated with HdIVIg. Adults appeared less likely to respond (48%) than children (90%) and the duration of response was also more prolonged in children. Adjunctive therapy in adults was more effective than monotherapy (59% vs 0%), whereas monotherapy was effective in 90% of children. HdIVIg may offer a safe potential therapeutic avenue for resistant cases of atopic dermatitis, particularly in children, but should be further assessed using double-blind placebo-controlled trials.