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Nadig PL, Joshi V, Pilania RK, Kumrah R, Kabeerdoss J, Sharma S, Suri D, Rawat A, Singh S. Intravenous Immunoglobulin in Kawasaki Disease-Evolution and Pathogenic Mechanisms. Diagnostics (Basel) 2023; 13:2338. [PMID: 37510082 PMCID: PMC10378342 DOI: 10.3390/diagnostics13142338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Kawasaki disease (KD) is an acute vasculitis of childhood that affects the medium vessels with a special predilection to the involvement of coronary arteries. The major morbidity of this disease is due to coronary artery aneurysm, which occurs in about 25-30% of untreated cases. For decades now, intravenous immunoglobulin (IVIg) has consistently been shown to reduce the risk of CAAs to less than 5%. However, the mechanism of immunomodulation remains unclear. Several studies on the role of IVIg in the modulation of toll-like receptor pathways, autophagy, and apoptosis of the mononuclear phagocytic system, neutrophil extracellular trap, and dendritic cell modulation suggest a modulatory effect on the innate immune system. Similarly, certain studies have shown its effect on T-cell differentiation, cytokine release, and regulatory T-cell function. In this review, we discuss the potential mechanisms underlying the immunomodulatory actions of IVIg in patients with Kawasaki disease. Furthermore, we provide a summary of the evidence regarding various infusion protocols and dosages utilized in the treatment of KD patients.
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Affiliation(s)
- Pallavi L Nadig
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Vibhu Joshi
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Rajni Kumrah
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Jayakanthan Kabeerdoss
- Pediatric Biochemistry Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Saniya Sharma
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Deepti Suri
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Amit Rawat
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Li G, Wang T, Gou Y, Zeng R, Liu D, Duan Y, Liu B. Letter to the editor regarding "Value of C-reactive protein/albumin ratio in predicting intravenous immunoglobulin-resistant Kawasaki disease - A data from multi-institutional study in China". Int Immunopharmacol 2021; 95:107631. [PMID: 33896753 DOI: 10.1016/j.intimp.2021.107631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Gang Li
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China.
| | - Ting Wang
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Yongying Gou
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Rumeng Zeng
- Neonatal Department, Dujiangyan Medical Center, Sichuan, China
| | - Dong Liu
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Yan Duan
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Bin Liu
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China.
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Yeo JS, Choi JW. Effectiveness of Medium-Dose Intravenous Immunoglobulin (1 g/kg) in the Treatment of Kawasaki Disease. Korean Circ J 2010; 40:81-5. [PMID: 20182593 PMCID: PMC2827807 DOI: 10.4070/kcj.2010.40.2.81] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 07/29/2009] [Accepted: 08/14/2009] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives High-dose intravenous immunoglobulin (IVIG) (2 g/kg) is usually given in the treatment of Kawasaki disease (KD). According to the authors' experience, however, medium-dose immunoglobulin (1 g/kg) was also effective in the majority of patients. We performed a retrospective clinical study to validate effectiveness of the medium-dose regimen in treatment of KD. Subjects and Methods A total of 274 patients with KD who were treated with medium-dose immunoglobulin at Bundang Jesaeng General Hospital from July 1998 to October 2007 were enrolled. Results Medium-dose immunoglobulin was given once in 220 patients (group A; 80.3%) and twice or more in 54 patients (group B; 19.7%). Age and gender distributions, duration of fever before treatment, hemoglobin concentrations, and white blood cell and platelet counts did not differ significantly between the two groups (p>0.05). Concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase, and bilirubin were significantly higher in group B (p<0.005). Coronary arterial lesions (CAL) were found in 51 patients (23.2%) in group A and in 26 patients (48.1%) in group B during the acute stage, and in 14 patients (6.4%) in group A and in 11 patients (20.4%) in group B during the convalescent stage (p<0.005, respectively). A giant aneurysm was found in one patient in each group (0.5% in group A and 1.9% in group B; p<0.005) during the follow-up period. Conclusion A single infusion of medium-dose immunoglobulin was effective in 80% of patients with KD. About 20% of patients required two or more infusions of medium-dose immunoglobulin, who had higher concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase and bilirubin. The authors think that the medium-dose regimen proffers an advantage over the high-dose regimen in view of cost-effectiveness.
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Affiliation(s)
- Joong-Seok Yeo
- Department of Pediatrics, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
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Cho HG, Cho YK, Ma JS. The characteristic laboratory findings of non-responsiveness to intravenous immunoglobulin in children with Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2010. [DOI: 10.3345/kjp.2010.53.2.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Han Gil Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
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Abstract
Intravenous immunoglobulin G (IVIG) has become increasingly important both as replacement therapy in primary and acquired humoral immunodeficiency and as an immunomodulatory therapy in autoimmune disease and transplantation. Multiple potential mechanisms for the effects of IVIG have now been recognized but the contribution of each mechanism in different diseases is uncertain. IVIG is generally well tolerated but serious side effects can occur and need to be addressed. IVIG has Food and Drug Administration (FDA) approval for a half dozen indications but these account for only about half the use of IVIG. This chapter reviews the development of IVIG for primary immunodeficiency, the evidence for efficacy of IVIG in autoimmune and inflammatory conditions, the risks associated with administration of IVIG, and steps that can be taken to minimize adverse events.
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Affiliation(s)
- R John Looney
- Department of Medicine, Allergy, Immunology, Rheumatology Unit, School of Medicine and Dentistry, University of Rochester, 595 Elmwood Ave, Room G-6454, Rochester, NY 14642, USA.
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Abstract
The primary systemic vasculitides are a rare group of inflammatory disorders, where damage is directed against the blood vessels. They range in severity from acute self-limiting illness to chronic life and organ threatening diseases requiring long-term treatment with toxic immunosuppressive regimes. None of them have specific tests and few have hard diagnostic criteria. This review summarises the gastrointestinal features of these diseases, along with their general clinical and epidemiological features and the evidence available to guide in their management.
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Affiliation(s)
- Matthew D Morgan
- Department of Renal Immunobiology, The Medical School, Vincent Drive, Edgbaston, Birmingham B15 2TT, UK.
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Oates-Whitehead RM, Baumer JH, Haines L, Love S, Maconochie IK, Gupta A, Roman K, Dua JS, Flynn I. Intravenous immunoglobulin for the treatment of Kawasaki disease in children. Cochrane Database Syst Rev 2003; 2003:CD004000. [PMID: 14584002 PMCID: PMC6544780 DOI: 10.1002/14651858.cd004000] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. The coronary arteries supplying the heart can be damaged in Kawasaki disease. The principal advantage of timely diagnosis is the potential to prevent this complication with early treatment. Intravenous immunoglobulin (IVIG) is widely used for this purpose. OBJECTIVES The objective of this review was to evaluate the effectiveness of IVIG in treating, and preventing cardiac consequences, of Kawasaki disease in children. SEARCH STRATEGY Electronic searches of the Cochrane Peripheral Vascular Disease Group Specialised Register, CENTRAL, MEDLINE, EMBASE, and CINAHL were performed (last searched April 2003). We also searched references from relevant articles and contacted authors where necessary. In addition we contacted experts in the field for unpublished works. SELECTION CRITERIA Randomised controlled trials of intravenous immunoglobulin to treat Kawasaki disease were eligible for inclusion. DATA COLLECTION AND ANALYSIS Fifty-nine trials were identified in the initial search. On careful inspection only sixteen of these met all the inclusion criteria. Trials were data extracted and assessed for quality by at least two reviewers. Data were combined for meta-analysis using relative risk ratios for dichotomous data or weighted mean difference for continuous data. A random effects statistical model was used. MAIN RESULTS The meta-analysis of IVIG versus placebo, including all children, showed a significant decrease in new coronary artery abnormalities (CAAs) in favour of IVIG, at thirty days RR (95% CI) = 0.74 (0.61 to 0.90). No statistically significant difference was found thereafter. A subgroup analysis excluding children with CAAs at enrollment also found a significant reduction of new CAAs in children receiving IVIG RR (95%) = 0.67 (0.46 to 1.00). There was a trend towards benefit from IVIG at sixty days (p=0.06). Results of dose comparisons showed a decrease in the number of new CAAs with increased dose. The meta-analysis of 400 mg/kg/day for five days versus 2 gm/kg in a single dose showed statistically significant reduction in CAAs at thirty days RR (95%) = 4.47 (1.55 to 12.86). This comparison also showed a significant reduction in duration of fever with the higher dose. There was no statistically significant difference noted between different preparations of IVIG. There was no statistically significant difference of adverse effects in any group. REVIEWER'S CONCLUSIONS Children fulfilling the diagnostic criteria for Kawasaki disease should be treated with IVIG (2 gm/kg single dose) within 10 days of onset of symptoms.
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Affiliation(s)
- R M Oates-Whitehead
- Research Division, Royal College of Paediatrics, 50 Hallam Street, London, UK, W1W 6DE
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8
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Abstract
Kawasaki disease is a systemic vasculitis of unknown aetiology that has been reported worldwide since its initial description in Japanese children. The most significant sequelae of acute Kawasaki disease are related to the inflammation of small to medium sized arteries and, in particular, the development of coronary artery aneurysms. Because the aetiology is unknown, pharmacological therapy is nonspecific and directed towards modulation of the inflammatory response and inhibition of platelet activation with the aim of preventing coronary artery aneurysms. In the US, the recommended treatment for Kawasaki disease in the acute phase is a single, high dose of intravenous gammaglobulin (2 g/kg) and high dose aspirin (80 to 100 mg/kg/day). Use of this regimen has resulted in a significant decrease in the incidence of coronary artery abnormalities. Although the American Heart Association currently recommends high dose aspirin, moderate doses are used in Japan and the optimal dose of aspirin is not known. There has been renewed interest in the use of corticosteroids in the treatment of acute Kawasaki disease: however, their precise role remains unclear. Newer antiplatelet agents have also shown some promise in the treatment of patients with coronary artery aneurysms. Long term pharmacological therapy consists primarily of anticoagulation in patients with persistent coronary artery abnormalities. In this review, current recommendations for pharmacological therapy in Kawasaki disease are reviewed and some of the controversies in management of this disease, including management of patients who do not respond to initial therapy and the role of corticosteroids in the acute setting, are outlined.
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Affiliation(s)
- R V Williams
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Medical Center, Salt Lake City 84113, USA.
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9
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Abstract
Kawasaki disease is a leading cause of acquired heart disease in children in the USA. An acute vasculitis of unknown etiology, it occurs predominantly in infancy and early childhood, and more rarely in teenagers. Coronary artery aneurysms or ectasia develop in approximately 15-25% of children with the disease. Treatment with intravenous gamma globulin, 2 g per kg, in the acute phase reduces this risk three- to fivefold. Angiographic resolution occurs in approximately one-half of aneurysmal arterial segments, but these show persistent histologic and functional abnormalities. The remainder continue to be aneurysmal, often with development of progressive stenosis or occlusion. The worst prognosis occurs in children with so-called 'giant aneurysms', i.e. those with a maximum diameter greater than 8 mm, because thrombosis is promoted both by sluggish blood flow within the massively dilated vascular space and by the frequent development of stenotic lesions. Serial stress tests with myocardial imaging are mandatory in the management of patients with Kawasaki disease and significant coronary artery disease to determine the need for coronary angiography and transcatheter interventions or coronary bypass surgery. Continued long-term surveillance in patients with and without detected coronary abnormalities is necessary to determine the natural history of Kawasaki disease.
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Affiliation(s)
- J W Newburger
- Department of Cardiology, Children's Hospital, Boston, MA 02115, USA
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Sawaji Y, Haneda N, Yamaguchi S, Kajino Y, Kishida K, Seto S, Konishi N, Waki K, Baba K, Arisawa K, Kamiya T, Mori C. Coronary risk factors in acute Kawasaki disease: correlation of serum immunoglobulin levels with coronary complications. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1998; 40:218-25. [PMID: 9695293 DOI: 10.1111/j.1442-200x.1998.tb01915.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine the usefulness of the IgG z-score (age and sex-standardized serum IgG level) before intravenous gamma globulin therapy (IVGG) in predicting the occurrence or severity of coronary complications in Kawasaki disease (KD). METHODS A case-control study of clinical and laboratory findings with 88 children in the early stage of acute KD who received IVGG (100 or 200 mg/kg for 2-5 days) therapy. Of these, 20 cases had persistent coronary arterial lesions (small aneurysm, moderate aneurysm or large aneurysm persisting more than 1 month). The controls comprised 68 children with no coronary aneurysms or transient small aneurysm only observed within 1 month after the onset of KD. The association between serum levels of immunoglobulin G (IgG). IgM, IgA as well as other coronary risk factors previously reported and the occurrence of the coronary arterial lesions was evaluated using logistic regression analysis. RESULTS After adjustment for age, gender, total IVGG dose before the 9th illness day and other traditional coronary risk factors, the odds ratio for the persistent coronary aneurysm associated with lower serum IgG z-score (< -0.7485 vs > or = -0.7485), was 30.3 (95% confidence interval, 3.8-243.2). Furthermore, the serum IgG z-score was inversely correlated with the severity of the coronary arterial lesion. CONCLUSIONS The IgG z-score before IVGG therapy in the early stage of KD provides useful information on the risk factors for persistent coronary aneurysm and is a novel, additional indicator for therapy to prevent the coronary complications in acute KD.
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Affiliation(s)
- Y Sawaji
- Department of Pediatrics, Shimane Medical University, Izumo, Japan
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11
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Abstract
Kawasaki disease is the leading cause of acquired heart disease in children in many parts of the world. It is an acute systemic vasculitis of unknown etiology predominantly affecting children under 5 years of age. It is diagnosed clinically by the presence of a constellation of manifestations and exclusion of other diseases with similar findings. Children develop a spectrum of cardiovascular manifestations including coronary artery involvement in 30-35% of untreated cases with myocardial infarction and death in < or = 2% of them. Acute stage treatment is by administration of intravenous immunoglobulin and aspirin. Those with coronary artery involvement need long-term cardiac risk stratification and management because many of them will become the part of a growing pool of adults with ischemic heart disease.
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Affiliation(s)
- G K Singh
- Division of Pediatric Cardiology, St. Louis University School of Medicine, MO, USA
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12
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Terai M, Shulman ST. Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin dose but independent of salicylate dose. J Pediatr 1997; 131:888-93. [PMID: 9427895 DOI: 10.1016/s0022-3476(97)70038-6] [Citation(s) in RCA: 281] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The efficacy of intravenous gamma globulin (IVGG) for treatment of Kawasaki disease (KD) is clearly established. In a metaanalysis, we reviewed U.S. and Japanese multicenter, randomized controlled studies regarding the effect of various doses of IVGG with aspirin administered within the first 7 to 10 days of illness on the prevalence of coronary artery abnormalities in KD. We studied 1629 patients with acute KD from the six reported studies that included blinded echocardiographic assessments. In 868 Japanese patients treated with moderate-dose aspirin (30 to 50 mg/kg per day), the prevalence of coronary abnormalities at the subacute stage (illness day 30) was 26.8% with aspirin alone, 18.1% with total IVGG dose < 1 gm/kg, 17.3% with total IVGG of 1.0 to 1.2 g/kg, and 5.3% with total IVGG of 2 gm/kg; the corresponding prevalence at the convalescent stage of illness (illness day 60) was 17.5%, 13.5%, 9.8%, and 3.5%, respectively. In 761 U.S. patients treated with high-dose aspirin (80 to 120 mg/kg per day), the prevalence of coronary abnormalities at the subacute stage (2 to 3 weeks after enrollment) was 23.0% with aspirin alone, 9.0% with total IVGG of 1.0 gm/kg, 8.6% with total IVGG of 1.6 gm/kg, and 4.6% with total IVGG of 2.0 gm/kg; corresponding prevalence at the convalescent stage (6 to 8 weeks after enrollment) was 17.7%, 9.0%, 6.3%, and 3.8%, respectively. When all data for the 1629 patients were combined, the prevalence at the subacute stage was 25.8% with aspirin alone, 18.1% with IVGG < 1 gm/kg, 15.7% with IVGG of 1 to 1.2 gm/kg, 8.6% with IVGG of 1.6 gm/kg, and 4.8% with IVGG of 2 gm/kg (adjusted R2 = 0.966, p = 0.0017); corresponding prevalence at the convalescent stage was 17.6%, 13.5%, 9.7%, 6.3%, and 3.8%, respectively (adjusted R2 = 0.993, p = 0.0602). The prevalence of coronary abnormalities was inversely related to the total dose of IVGG and was independent of the aspirin dose. We conclude that 2 gm/kg IVGG combined with at least 30 to 50 mg/kg per day aspirin provides maximum protection against development of coronary abnormalities after KD.
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Affiliation(s)
- M Terai
- Department of Pediatrics, Northwestern University Medical School, Children's Memorial Hospital, Chicago, Illinois 60614, USA
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Scott-Moncrieff JC, Reagan WJ. Human intravenous immunoglobulin therapy. SEMINARS IN VETERINARY MEDICINE AND SURGERY (SMALL ANIMAL) 1997; 12:178-85. [PMID: 9283243 DOI: 10.1016/s1096-2867(97)80031-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Human intravenous immunoglobulin (hIVIG) is a preparation of normal polyspecific IgG obtained from the plasma of healthy blood donors. Although purified immunoglobulins were initially developed for treatment of primary immunodeficiency syndromes, they have since been documented to be effective in the treatment of some immune-mediated diseases such as immune-mediated thrombocytopenia purpura and autoimmune hemolytic anemia. Blockade of Fc receptors on mononuclear phagocytic cells has been proposed as the most likely mechanism for the rapid early response to hIVIG treatment. Human IVIG has been used to treat canine immune-mediated hemolytic anemia (IMHA), anemia with myelofibrosis, and immune-mediated thrombocytopenia. Doses from 0.5 to 1.5 g/kg may be effective, although most studies have used a dose of 1 g/kg. Human IVIG is administered as an intravenous infusion over 6 to 12 hours, and dogs should be carefully monitored for adverse reactions during administration. The possibility of a increased risk of thromboembolism should be considered when undertaking hIVIG treatment. The safety of multiple treatments of hIVIG has not been established. In most dogs with IMHA, benefit may be limited to short-term improvement in hematocrit, which may allow time for other treatment modalities to become effective. Dogs with nonregenerative anemia and associated myelofibrosis may have longer-term responses to hIVIG treatment.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/immunology
- Anemia, Hemolytic, Autoimmune/therapy
- Anemia, Hemolytic, Autoimmune/veterinary
- Animals
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/immunology
- Autoimmune Diseases/veterinary
- Dog Diseases/blood
- Dog Diseases/immunology
- Dog Diseases/therapy
- Dogs
- Humans
- Immunization, Passive/methods
- Immunization, Passive/veterinary
- Immunoglobulins, Intravenous/administration & dosage
- Immunoglobulins, Intravenous/adverse effects
- Immunoglobulins, Intravenous/therapeutic use
- Primary Myelofibrosis/immunology
- Primary Myelofibrosis/therapy
- Primary Myelofibrosis/veterinary
- Thrombocytopenia/immunology
- Thrombocytopenia/therapy
- Thrombocytopenia/veterinary
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Affiliation(s)
- J C Scott-Moncrieff
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN 47907, USA
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Affiliation(s)
- R I Schiff
- Division of Allergy and Immunology, Duke University Medical Center, Dunham, NC 27710
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Dajani AS, Taubert KA, Gerber MA, Shulman ST, Ferrieri P, Freed M, Takahashi M, Bierman FZ, Karchmer AW, Wilson W. Diagnosis and therapy of Kawasaki disease in children. Circulation 1993; 87:1776-80. [PMID: 8491037 DOI: 10.1161/01.cir.87.5.1776] [Citation(s) in RCA: 321] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A S Dajani
- American Heart Association, Dallas, TX 75231-4596
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17
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Abstract
The role of Kawasaki disease (KD) as a contributor to early childhood cardiac morbidity in Adelaide was investigated by a review of hospital admission and case-note data from January 1979 to June 1990. There were 57 episodes in 55 patients. The epidemiological data in this South Australian series are similar to that seen in other Australian and New Zealand centres and correlate better with the clinical data from North America than from Japan. The average age of admission was 3.2 years (median 2.7 years) with 38 and 85% of cases being less than 2 and 5 years respectively. The male to female ratio was 1.5. The incidence of KD in the 0-5 year age group was 3.9 cases per 100,000 children. This series represents a minimum number of cases for this period and illustrates an association of aneurysm-risk with prolonged fever; improved defervescence with the combination of intravenous gamma-globulin (IVGG) and aspirin compared with aspirin alone; and a more severe disease process in the very young. The series supports the efficacy of single dose IVGG therapy. Antibiotics were given prior to diagnosis of KD in 79% of patients, often causing diagnostic confusion with possible drug reactions. The pathogenic mechanisms of KD are reviewed and a new hypothesis is proposed that incorporate mechanisms of vessel pathology resulting from release of endothelin and recognized mediators of endothelial damage including tumour necrosis factor-alpha and interleukin-1 beta.
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Affiliation(s)
- P K Smith
- Adelaide Children's Hospital, Australia
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18
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Salo E. Kawasaki disease in Finland in 1982-1992. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1993; 25:497-502. [PMID: 8248750 DOI: 10.3109/00365549309008532] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Data on patients suffering from Kawasaki disease have been collected prospectively in Finland since 1981. To ascertain the incidence, treatment and outcome in these patients the data were analysed for the 10-year period April 1982 to March 1992. Kawasaki disease was confirmed in 229 patients. The annual attack rate varied from 3.1 to 7.2 per 100,000 children below the age of 5 years. Their mean age was 3.9 years (range: 7 weeks to 39 years). 40% were under 2 years and 71% under 5 years of age. There was 1 adult patient. The male/female ratio was 1.5:1. Coronary artery lesions were found in 28 patients, 2 of whom died of myocardial infarction. Since April 1985, 132 patients (73%) have been treated with intravenous immunoglobulin. When treatment was begun before day 7 of the disease, coronary artery lesions were found in 5.5%; when begun between days 7 and 10, in 12%, and when begun after day 10, in 28% of the patients.
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Affiliation(s)
- E Salo
- Helsinki University Children's Hospital, Finland
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19
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Abstract
A great variety of problems referable to the cardiovascular system can prompt a visit to the pediatric emergency room. From the initial presentation of congenital heart disease, to the subsequent life-long management of these patients, to miscellaneous problems like Kawasaki disease and chest pain, the front-line pediatrician must be skilled in the recognition and early management of myriad complaints. This article focuses on information that can assist the emergency pediatrician in the evaluation and treatment of the cardiac patient from arrival in the emergency room until transfer of care to the pediatric cardiologist or inpatient staff.
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Affiliation(s)
- P A Flynn
- Division of Pediatric Cardiology, New York Hospital, Cornell University Medical College, New York
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21
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Dunsmore KP, Friedman HS, Kurtzberg J. The uses of intravenous immunoglobulin in pediatrics. An update. Crit Rev Oncol Hematol 1992; 12:67-90. [PMID: 1590942 DOI: 10.1016/1040-8428(92)90085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- K P Dunsmore
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710
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Affiliation(s)
- J M Dwyer
- Division of Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
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Rowley AH, Gonzalez-Crussi F, Shulman ST. Kawasaki syndrome. CURRENT PROBLEMS IN PEDIATRICS 1991; 21:387-405. [PMID: 1743048 DOI: 10.1016/0045-9380(91)90008-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A H Rowley
- Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois
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Newburger JW, Takahashi M, Beiser AS, Burns JC, Bastian J, Chung KJ, Colan SD, Duffy CE, Fulton DR, Glode MP. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med 1991; 324:1633-9. [PMID: 1709446 DOI: 10.1056/nejm199106063242305] [Citation(s) in RCA: 788] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Treatment of acute Kawasaki syndrome with a four-day course of intravenous gamma globulin, together with aspirin, has been demonstrated to be safe and effective in preventing coronary-artery lesions and reducing systemic inflammation. We hypothesized that therapy with a single, very high dose of gamma globulin would be at least as effective as the standard regimen. METHODS We conducted a multicenter, randomized, controlled trial involving 549 children with acute Kawasaki syndrome. The children were assigned to receive gamma globulin either as a single infusion of 2 g per kilogram of body weight over 10 hours or as daily infusions of 400 mg per kilogram for four consecutive days. Both treatment groups received aspirin (100 mg per kilogram per day through the 14th day of illness, then 3 to 5 mg per kilogram per day). RESULTS The relative prevalence of coronary abnormalities, adjusted for age and sex, among patients treated with the four-day regimen, as compared with those treated with the single-infusion regimen, was 1.94 (95 percent confidence limits, 1.01 and 3.71) two weeks after enrollment and 1.84 (95 percent confidence limits, 0.89 and 3.82) seven weeks after enrollment. Children treated with the single-infusion regimen had lower mean temperatures while hospitalized (day 2, P less than 0.001; day 3, P = 0.004), as well as a shorter mean duration of fever (P = 0.028). Furthermore, in the single-infusion group the laboratory indexes of acute inflammation moved more rapidly toward normal, including the adjusted serum albumin level (P = 0.004), alpha 1-antitrypsin level (P = 0.007), and C-reactive protein level (P = 0.017). Lower IgG levels on day 4 were associated with a higher prevalence of coronary lesions (P = 0.005) and with a greater degree of systemic inflammation. The two groups had a similar incidence of adverse effects (including new or worsening congestive heart failure in nine children), which occurred in 2.7 percent of the children overall. All the adverse effects were transient. CONCLUSIONS In children with acute Kawasaki disease, a single large dose of intravenous gamma globulin is more effective than the conventional regimen of four smaller daily doses and is equally safe.
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Affiliation(s)
- J W Newburger
- Department of Cardiology, Children's Hospital, Boston, MA 02115
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Affiliation(s)
- A H Rowley
- Division of Infectious Diseases, Children's Memorial Hospital, Chicago, IL 60614
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Barron KS, Murphy DJ, Silverman ED, Ruttenberg HD, Wright GB, Franklin W, Goldberg SJ, Higashino SM, Cox DG, Lee M. Treatment of Kawasaki syndrome: a comparison of two dosage regimens of intravenously administered immune globulin. J Pediatr 1990; 117:638-44. [PMID: 2213395 DOI: 10.1016/s0022-3476(05)80707-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Because intravenously administered immune globulin (IVIG) is effective in reducing the incidence of coronary artery aneurysms in Kawasaki syndrome when given at a dose of 400 mg/kg daily for 4 days, we undertook a multicenter clinical trial comparing two dosage regimens of IVIG. Patients were randomly assigned to receive IVIG at either 400 mg/kg daily for 4 days (22 patients) or 1 gm/kg as a single dose (22 patients). All patients received aspirin therapy, and all were enrolled within 7 days of onset of fever. The presence of coronary artery aneurysms was evaluated by means of two-dimensional echocardiography before infusion; at days 4 to 6, 14 to 21, and 42 to 49 after infusion; and at 1 year. Coronary artery aneurysms were detected in 3 of the 44 patients, including one patient receiving 400 mg/kg and two patients receiving 1 gm/kg (p value not significant). No giant aneurysms were detected. No major side effects occurred with either dosage regimen. Patients receiving the 1 gm/kg dose had a faster resolution of fever and were discharged from the hospital approximately 1 day sooner than the 400 mg/kg group (p = 0.01). Although the relatively small sample size in this trial does not allow for a more definitive statement regarding the occurrence of coronary artery aneurysms, it appears that the 1 gm/kg dose is associated with a more rapid clinical improvement and a shorter hospital stay.
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Bharati S, Engle MA, Fatica NS, Bussell JB, Sulayman RF, Lev M, Lynfield J. The heart and conduction system in acute Kawasaki disease: report of fraternal cases--one lethal, one relapsing. Am Heart J 1990; 120:359-65. [PMID: 1696427 DOI: 10.1016/0002-8703(90)90080-h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The heart and conduction system were studied in a 4 1/2-year-old boy with Kawasaki disease who died suddenly in the early phase of illness. Severe perivasculitis, neuritis, pancarditis, and involvement of all parts of the specialized conduction system were found. The boy's brother, born a year later, at the age of 12 months had relapsing Kawasaki disease. He received intravenous gamma globulin and recovered.
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Affiliation(s)
- S Bharati
- Congenital Heart and Conduction System Center, Palos Heights, IL 60463
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