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Acta Derm Venereol. 2003;83(6):433-7.

Adjunctive high-dose intravenous immunoglobulin treatment for resistant atopic dermatitis: efficacy and effects on intracellular cytokine levels and CD4 counts.

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  • 1National Institute for Medical Research, Division of Infection and Immunity, The Ridgeway, Mill Hill, London, UK.


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-gamma and TNF-alpha 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.

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