Allergy Asthma Immunol Res.  2016 Jul;8(4):375-382. 10.4168/aair.2016.8.4.375.

Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: Long-Term Changes of Clinical Severity and Laboratory Parameters

• Nahm DH
• Ahn A
• Kim ME
• Cho SM
• Park MJ

• KMID: 2165921
• DOI: http://doi.org/10.4168/aair.2016.8.4.375

Abstract

This report evaluated long-term changes in clinical severity and laboratory parameters in 3 adult patients with severe recalcitrant atopic dermatitis (AD) who were treated with intramuscular injections of 50 mg of autologous immunoglobulin G (IgG) twice a week for 4 weeks (autologous immunoglobulin therapy, AIGT) and followed up for more than 2 years after the treatment. We observed the following 4 major findings in these 3 patients during the long-term follow-up after AIGT. (1) Two of the 3 patients showed a long-term clinical improvement for more than 36 weeks after AIGT with a maximum decrease in clinical severity score greater than 80% from baseline. (2) These 2 patients also showed long-term decreases in serum total IgE concentrations and peripheral blood eosinophil count for more than 36 weeks after AIGT with a maximum decrease in the two laboratory parameters of allergic inflammatory greater than 70% from baseline. (3) No significant side effect was observed during the 2 years of follow-up period after the AIGT in all 3 patients. (4) Serum levels of IgG anti-idiotype antibodies to the F(ab')2 fragment of autologous IgG administered for the treatment were not significantly changed after AIGT in all 3 patients. These findings suggest that AIGT has long-term favorable effects on both clinical severity and laboratory parameters in selected patients with severe recalcitrant AD. Further studies are required to evaluate the clinical usefulness and therapeutic mechanism of AIGT for AD.

Keyword

Dermatitis, atopic; immunoglobulins; immunomodulation; therapy; antibodies; immunoglobulin G

MeSH Terms

Adult
Antibodies
Antibodies, Anti-Idiotypic
Dermatitis, Atopic*
Eosinophils
Follow-Up Studies
Humans
Immunization, Passive*
Immunoglobulin E
Immunoglobulin G
Immunoglobulins*
Immunomodulation
Injections, Intramuscular
Antibodies
Antibodies, Anti-Idiotypic
Immunoglobulin E
Immunoglobulin G
Immunoglobulins

Figure

• 

  Fig. 1 Long-term changes in clinical severity scores (SCORAD value) and laboratory parameters in a patient with severe recalcitrant atopic dermatitis who was treated with intramuscular injections of 50 mg autologous immunoglobulin G twice a week for 4 weeks (case 1). The arrows indicate the timing of the injection of autologous immunoglobulin.

• 

  Fig. 2 Long-term changes in clinical severity scores (SCORAD value) and laboratory parameters in another patient with severe recalcitrant atopic dermatitis who was treated with intramuscular injections of 50 mg autologous immunoglobulin G twice a week for 4 weeks (case 2). The arrows indicate the timing of the injection of autologous immunoglobulin.

• 

  Fig. 3 Long-term changes in clinical severity scores (SCORAD value) and laboratory parameters in the third patient with severe recalcitrant atopic dermatitis who were treated with intramuscular injections of 50 mg autologous immunoglobulin G twice a week for 4 weeks (case 3). The arrows indicate the timing of the injection of autologous immunoglobulin.

• 

  Fig. 4 Photographs of 2 patients with severe recalcitrant atopic dermatitis who were treated with intramuscular injections of 50 mg autologous immunoglobulin G twice a week for 4 weeks. Photographs of 1 patient (case 1) at baseline before the treatment (A), at 24 weeks (B), and at 96 weeks after the treatment (C). Photographs of another patient (case 2) at baseline before the treatment (D), at 24 weeks (E), and at 40 weeks after the treatment (F).

• 

  Fig. 5 Changes in the levels of IgG anti-idiotype antibodies to the F(ab')2 fragment of autologous IgG administered in serum samples of 3 adult patients with severe recalcitrant atopic dermatitis who were treated with intramuscular injections of 50 mg autologous immunoglobulin G twice a week for 4 weeks. The levels of IgG anti-idiotype antibodies are expressed as absorbance value measured by enzyme-linked immunosorbent assay.

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