High-dose Intravenous Immunoglobulin Downregulates the Activated Levels of Inflammatory Indices Except Erythrocyte Sedimentation Rate in Acute Stage of Kawasaki Disease

Abstract

We evaluated the effects of high-dose intravenous immunoglobulin (IVIG) administration on various protein parameters, including inflammatory profiles, in children with Kawasaki disease (KD). Sixty-three children with KD were treated with IVIG at 2 g/kg over 12 h. Serial examinations of laboratory indices were performed three times: before IVIG treatment, 24 h after IVIG treatment, and 7 days after IVIG treatment. The white blood cell and neutrophil counts showed significant decreases 24 h and 7 days after IVIG administration. The erythrocyte sedimentation rate (ESR) increased significantly 24 h after IVIG, and the elevated level was sustained for 7 days. The levels of hemoglobin, albumin and inflammation-associated proteins, including C-reactive protein, decreased 24 h after IVIG treatment. Inflammation-associated proteins, except transferrin, decreased further to near normal levels after 7 days. On the other hand, IgM and IgA were not affected after 24 h, rather increased significantly after 7 days. High-dose IVIG causes immediate changes in the levels of various proteins, except IgA and IgM, and downregulates the activated levels of inflammatory indices, except ESR, in the acute stage of KD.

Retinal vein occlusion following intravenous immunoglobulin treatment

“…The mechanism of thrombosis secondary to IVIg is unknown but it is attributed to the resultant hyperviscosity of blood, as IVIg can cause remarkable biochemical and hematological changes [2,9,10]. Furthermore such changes are often confused with a serious medical problem such as disease reactivity.…”

“…Furthermore such changes are often confused with a serious medical problem such as disease reactivity. ESR is elevated due to enhanced rouleaux formation, polymerisation between proteins and reduced surface area caused by the infused IVIg [10]. In addition, IVIg reportedly cause platelet activation and arterial vasospasm [2,4].…”

“…In addition, IVIg reportedly cause platelet activation and arterial vasospasm [2,4]. These viscous effects are dose dependent and can last for weeks, increasing susceptibility to thromboembolism [9,10]. Across the world, irrespective of brands IVIg related thrombotic complications have been reported, generally occurring between 1-14 days of the therapy [4,5].…”

Doença de Kawasaki

“…3 A imunoglobulina intravenosa (IGIV) é o principal medicamento na doença de Kawasaki, sendo utilizada na fase aguda, preferencialmente nos primeiros sete a 10 dias da doença, a fim de diminuir a prevalên-cia de anormalidades das artérias coronárias e abreviar a duração dos sintomas clínicos. 42,[63][64][65][66] Pode ainda normalizar mais rapidamente as proteínas inflamatórias de fase aguda -mas não a velocidade de hemossedimentação (VHS) -e melhorar a função miocárdica. 4,66 Em estudo retrospectivo recente concluiu-se que o início tardio da IGIV, após o oitavo dia de doença, reduz as chances de sucesso terapêutico.…”

“…42,[63][64][65][66] Pode ainda normalizar mais rapidamente as proteínas inflamatórias de fase aguda -mas não a velocidade de hemossedimentação (VHS) -e melhorar a função miocárdica. 4,66 Em estudo retrospectivo recente concluiu-se que o início tardio da IGIV, após o oitavo dia de doença, reduz as chances de sucesso terapêutico. 67 Os mecanismos de ação da IGIV permanecem desconhecidos; várias teorias têm sido aventadas para os possí-veis mecanismos como supressão de macrófagos e monócitos ativados, bloqueio da interação entre o endotélio e as células natural killers, estimulação de receptores inibitórios, modulação de produção de citocinas, neutralização de superantígenos bacterianos, diminuição da síntese de anticorpos e aumento da atividade de linfócitos T supressores.…”