Adjunctive High-dose Intravenous Immunoglobulin Treatment for Resistant Atopic Dermatitis: Efficacy and Effects on Intracellular Cytokine Levels and CD4 Counts
Stephen Jolles A1, Carrock Sewell A3, David Webster A3, Annie Ryan A3, Bridget Heelan A3, Annie Waite A4, Malcolm Rustin A4
Although atopic dermatitis generally responds to topical therapy, small numbers of patients have severe resistant disease despite second-line therapies. High-dose intravenous immunoglobulin has been suggested to be of benefit in a small number of reports. We have conducted an open, single-centre study of adjunctive high-dose intravenous immunoglobulin (Flebogamma® 5%). Six patients received treatment at 2 g kg?1 month?1 for 6 cycles, with a 3-month follow-up period. Skin scores, lymphocyte phenotypes and intracellular cytokine analysis were performed. Four of six patients had major improvements in skin scores and the overall reduction was significant (p=0.035). CD4+ T-cell numbers fell following high-dose intravenous immunoglobulin infusions, recovering by the next cycle. T-cell CD69 expression decreased to 60% of baseline values. Reductions in the proinflammatory cytokines IFN-? and TNF-? were non-significant. Adjunctive high-dose intravenous immunoglobulin may be a useful therapeutic approach in adults with severe treatment-resistant atopic dermatitis, but it will require further assessment in randomized controlled trials to establish this.