Use of Intravenous Immunoglobulin in the Treatment of Childhood Atopic Dermatitis

摘要: Atopic dermatitis (AD) is a chronically recurrent inflammatory skin disorder characterized by pruritus, specific distribution, and family history. It has recently been reported that the incidence of AD increased in Korea.1,2 Pruritus, sleep loss, dietary restrictions, psychosocial factors significantly decrease quality life for patients.3,4 Recently, European Academy Allergy Clinical Immunology American Allergy, Asthma, published PRACTALL consensus report diagnosis treatment children adults.5 The suggests stepwise management includes addition multiple therapeutic agents on basis disease severity. The defines severe or recalcitrant as cannot be controlled with topical treatment.6 In 2009 Korean Work Group Report severe/recalcitrant AD, defined SCORAD index higher than 50 conventional treatment,7 while 2008 Guideline Dermatitis Children 40.8 Specific criteria definition are necessary. For recommends systemic therapy such antimicrobial treatment, corticosteroids, cyclosporin A, azathioprine, anti-histamines, phototherapy, immunotherapy. Several reports, including Report, have described intravenous immunoglobulin (IVIg) one various immunoregulatory treatments. Nevertheless, this was not included report.7,9,10 IVIg displays immunomodulatory anti-inflammatory properties, its effectiveness several immune-mediated conditions Kawasaki idiopathic thrombocytopenic purpura demonstrated.11 IVIg considered candidate because ability to downregulate T-cell function, particularly interleukin-4 production.12,13 A small number observations efficiency reported, but prospective randomized studies clinical childhood sparse. randomized, placebo-controlled study patients therefore required.14 Jee et al.14 effects AD; however, involved moderate patients, it did include severity might affected results. Further strict recalcitrant/severe warranted. addition, effective dose, dosing interval initiation maintenance, identification biomarkers (e.g., ECP, ICAM-1, IL-5/INF-gamma) determine efficiency, clear indications all require consideration. Currently, we lack evidence-based data supporting use other immunomodulators AD. Before can recommended, cost-benefit ratio, course, duration, adverse reactions compared alternative options must determined. novel therapies should verified through repeated research numerous discussions.