An open-label study of high-dose intravenous immunoglobulin in severe childhood asthma

Eight pediatric patients with severe steroid-dependent asthma were enrolled in an open-label trial of high-dose intravenous immunoglobulin (IVIG) in an attempt to decrease their steroid requirements. Monthly therapy with high-dose IVIG resulted in a threefold decrease in both maintenance oral corticosteroid dose and in extra oral corticosteroids needed for control of exacerbations of asthma. This was accompanied by significant improvements in peak expiratory flow rates and in symptom-score rating. An immunomodulatory effect of IVIG was suggested by the changes in immediate skin test reactivity. Seven of the eight patients demonstrated one or more reactions to a panel of allergens before therapy. During the course of the trial, there was a progressive diminution in skin test reactivity with a 100-fold reduction in sensitivity at the completion of 6 months of therapy. In this preliminary study, the reduction in steroid requirements, improvement in symptoms and peak flow measurements, and diminution in immediate skin test reactivity support a potential role for IVIG in the treatment of severe steroid-dependent asthma. A larger, randomized trial now appears warranted.