Benefits of high-dose IV immunoglobulin in patients with severe steroid-dependent asthma

Study objective: To determine the efficacy of IV immunoglobulin (Mg) in severe asthma to reduce steroid requirements. Design: Pre- and posttreatment measurements were analyzed using Dunnett's multiple comparison procedure. Setting: Hospital clinical research center. Patients: Eleven adolescents and adults with severe, steroid-dependent asthma enrolled over a 14-month period. Interventions: IVIg was administered at a dose of 2 g/kg every 4 weeks for a total of seven infusions. Measurements ana results: Steroid requirements, pulmonary function including lung volumes, symptom scores, bone densitometry, and airway reactivity monitored by methacholine challenge were followed over the course of 7 months. A significant decrease in steroid usage was achieved. Despite substantial steroid reduction, the patients demonstrated improvement in their pulmonary function and symptom scores. The responses to methacholine challenge were unaffected by Mg treatment. Conclusions: IVIg provides a potentially important adjunctive therapy in severe asthma, reducing oral steroid requirements and steroid side effects without deterioration of lung function.