Mechanisms of glucocorticoid reduction in asthmatic subjects treated with intravenous immunoglobulin☆,☆☆,★
Section snippets
Study design
This was an open-label, 6-month study. To be eligible for participation, subjects had to have steroid-dependent asthma requiring at least 20 mg of prednisone or its equivalent on alternate days and to have no other respiratory conditions. Informed consent was obtained from all subjects, and the study was approved by the National Jewish Medical and Research Center’s Institutional Review Board. All subjects had optimal management of other medical conditions that can negatively influence asthma
Patient characteristics at baseline
Twelve subjects were recruited into the study. All of the subjects completed the study, but only 11 were included in the analysis. The excluded subject was diagnosed with a neutrophil defect after her second infusion. Her history was significant for having recurrent skin infections and pneumonias complicating her asthma. The mean age of the study subjects was 15.5 years, with an almost equal sex distribution (5 males and 6 females; Table I).Parameter Empty Cell
DISCUSSION
Airway inflammation plays a significant role in the pathogenesis of asthma.17 As a result, GCs have become an important modality of treatment. Various mechanisms of GC actions include inhibition of inflammatory cell influx, as well as inhibition of cytokine and mediator production by T cells and macrophages, which are important in the initiation and persistence of the inflammatory response.18, 19 Although the majority of asthmatic subjects respond favorably to GCs, a subpopulation of patients
Acknowledgements
We thank Beth Esterl, RN, and Cathy Hancock, RN, for their excellent technical assistance in this study. We also want to extend our gratitude to the physicians who referred the study patients and to the study patients and their families for without them, this study could not have been performed.
References (26)
- et al.
An open-label study of high-dose intravenous immunoglobulin in severe childhood asthma
J Allergy Clin Immunol
(1991) - et al.
Suppression of cytokine-dependent human T-cell proliferation by intravenous gammaglobulin
Clin Immunol Immunopathol
(1994) - et al.
Difficult-to-control asthma: clinical characteristics of steroid insensitive asthma
J Allergy Clin Immunol
(1998) Asthma and inflammation
J Allergy Clin Immunol
(1991)Glucocorticoid therapy for asthma: clinical pharmacology
J Allergy Clin Immunol
(1991)- et al.
Steroid-resistant asthma: immunologic and pharmacologic features
J Allergy Clin Immunol
(1992) - et al.
Difficult to control asthma evaluation and management
- et al.
Slight steroid-sparing effect of intravenous immunoglobulin in children and adolescents with moderately severe bronchial asthma
Allergy
(1994) - et al.
Intravenous immune globulin: an alternative therapy in steroid dependent allergic diseases
Clin Exp Immunol
(1996) - et al.
Reversal of immunoregulatory abnormalities in Kawasaki syndrome by intravenous gammaglobulin
J Clin Invest
(1987)
Corticosteroid resistance in chronic asthma
BMJ
Corticosteroid action and resistance in asthma
Am J Respir Crit Care Med
New insights into the pathogenesis and management of steroid-resistant asthma
J Asthma
Cited by (74)
Respiratory infectious burden in a cohort of antibody deficiency patients treated with immunoglobulin replacement therapy: The impact of lung pathology and gastroesophageal reflux disease
2023, Journal of Allergy and Clinical Immunology: GlobalAntibody Deficiency, Chronic Lung Disease, and Comorbid Conditions: A Case-Based Approach
2021, Journal of Allergy and Clinical Immunology: In PracticeIntravenous Immunoglobulin Therapy
2020, Comprehensive Dermatologic Drug Therapy, Fourth Edition46 - Severe Asthma
2019, Kendig's Disorders of the Respiratory Tract in Children
- ☆
Supported in part by the National Institutes of Health, grants AI-41022, HL-36577, HL-37260; General Clinical Research Center grant 5M01 RR00051 from the division of Research Resources; and a grant from Bayer Pharmaceuticals.
- ☆☆
Reprint requests: Joseph D. Spahn, MD, National Jewish Medical and Research Center, 1400 Jackson Street (K-926), Denver, CO 80206.
- ★
0091-6749/99 $8.00 + 0 1/1/94628