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The Role of Oral Administration of Immunoglobulin in Managing Diarrheal Illness in Immunocompromised Children

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Abstract

Introduction

Immunocompromised children are susceptible to infectious diarrhea. Oral administration of human serum immunoglobulins to treat immunocompromised patients with viral gastroenteritis caused by viruses like rotavirus and norovirus has been reported.

Objective

The aim of this study was to assess the efficacy of oral immunoglobulin (OIG) in treating hospitalized immunocompromised children with diarrheal illness.

Methods

We conducted a retrospective cohort review of the Mayo Clinic electronic medical records from January 1, 2005, through April 30, 2019. We included children who were immunocompromised and received OIG as a treatment for a diarrheal illness that was classified as acute (< 4 weeks) or chronic (> 4 weeks) at the time of their treatment. Response to therapy was defined by 50% reduction in stool output.

Results

Nineteen children were identified (11 males); average age at the time of treatment was 11 (0.25–18) years. In the acute diarrhea cohort, the mean duration of symptoms was 9.5 days (4–21). In the chronic diarrhea cohort, the mean duration of symptoms was 41 days (28–90). All 19 children were treated with OIG with doses in the range of 100–300 mg/kg/day for 1–5 days. Eighteen patients (95%) had improvement. Overall average time to response was 3.1 (1–9) days after receiving the OIG.

Conclusion

Oral administration of human serum immunoglobulin in immunocompromised children presenting with acute and chronic diarrheal illness appeared helpful in reducing stool output by 50% in the majority of patients.

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References

  1. Markowitz J, et al. A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease. Gastroenterology. 2000;119(4):895–902.

    Article  CAS  Google Scholar 

  2. Klotz U, Teml A, Schwab M. Clinical pharmacokinetics and use of infliximab. Clin Pharmacokinet. 2007;46(8):645–60.

    Article  CAS  Google Scholar 

  3. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357(25):2601–14.

    Article  CAS  Google Scholar 

  4. Barclay L, et al. Infection control for norovirus. Clin Microbiol Infect. 2014;20(8):731–40.

    Article  CAS  Google Scholar 

  5. Oka T, et al. Comprehensive review of human sapoviruses. Clin Microbiol Rev. 2015;28(1):32–533.

    Article  CAS  Google Scholar 

  6. Payne DC, et al. Norovirus and medically attended gastroenteritis in U.S. children. N Engl J Med. 2013;368(12):1121–30.

    Article  CAS  Google Scholar 

  7. Rockx B, et al. Natural history of human calicivirus infection: a prospective cohort study. Clin Infect Dis. 2002;35(3):246–53.

    Article  Google Scholar 

  8. Dennehy PH. Viral gastroenteritis in children. Pediatr Infect Dis J. 2011;30(1):63–4.

    Article  Google Scholar 

  9. Elliott EJ. Acute gastroenteritis in children. BMJ. 2007;334(7583):35–40.

    Article  Google Scholar 

  10. Gilger MA, et al. Extraintestinal rotavirus infections in children with immunodeficiency. J Pediatr. 1992;120(6):912–7.

    Article  CAS  Google Scholar 

  11. Wolffs PF, et al. Replacing traditional diagnostics of fecal viral pathogens by a comprehensive panel of real-time PCRs. J Clin Microbiol. 2011;49(5):1926–31.

    Article  Google Scholar 

  12. Kanfer EJ, et al. Severe rotavirus-associated diarrhoea following bone marrow transplantation: treatment with oral immunoglobulin. Bone Marrow Transplant. 1994;14(4):651–2.

    CAS  PubMed  Google Scholar 

  13. Losonsky GA, et al. Oral administration of human serum immunoglobulin in immunodeficient patients with viral gastroenteritis. A pharmacokinetic and functional analysis. J Clin Investig. 1985;76(6):2362–7.

    Article  CAS  Google Scholar 

  14. Williams D. Treatment of rotavirus-associated diarrhea using enteral immunoglobulins for pediatric stem cell transplant patients. J Oncol Pharm Pract. 2015;21(3):238–40.

    Article  CAS  Google Scholar 

  15. Guarino A, et al. Oral immunoglobulins for treatment of acute rotaviral gastroenteritis. Pediatrics. 1994;93(1):12–6.

    CAS  PubMed  Google Scholar 

  16. Hammarstrom V, Smith CI, Hammarstrom L. Oral immunoglobulin treatment in Campylobacter jejuni enteritis. Lancet. 1993;341(8851):1036.

    Article  CAS  Google Scholar 

  17. Rosario NA, et al. Oral immunoglobulin controls chronic diarrhea in common variable imunodefficiency (CVID). J Allergy Clin Immunol. 2017;139(2):Ab219.

    Article  Google Scholar 

  18. Florescu DF, et al. Is there a role for oral human immunoglobulin in the treatment for norovirus enteritis in immunocompromised patients? Pediatr Transplant. 2011;15(7):718–21.

    Article  CAS  Google Scholar 

  19. Shafran I, et al. Management of inflammatory bowel disease with oral serum-derived bovine immunoglobulin. Therap Adv Gastroenterol. 2015;8(6):331–9.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Erin Alexander, Michael C. Stephens, Mhd Louai Manini & Imad Absah

  2. Division of Pediatric Gastroenterology and Hepatology, Blank Children’s Hospital, Des Moines, IA, USA

    Salim Hommeida

  3. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Michael C. Stephens, Mhd Louai Manini & Imad Absah

Authors
  1. Erin Alexander
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  2. Salim Hommeida
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  3. Michael C. Stephens
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  4. Mhd Louai Manini
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  5. Imad Absah
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Corresponding author

Correspondence to Erin Alexander.

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Alexander, E., Hommeida, S., Stephens, M.C. et al. The Role of Oral Administration of Immunoglobulin in Managing Diarrheal Illness in Immunocompromised Children. Pediatr Drugs 22, 331–334 (2020). https://doi.org/10.1007/s40272-020-00389-0

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  • DOI: https://doi.org/10.1007/s40272-020-00389-0

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