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Intravenous Immunoglobulin: Dermatologic Uses and Mechanisms of Action

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Clinical and Basic Immunodermatology

Abstract

Intravenous immunoglobulin (IVIg) is a fractioned blood product consisting of pooled, polyvalent, IgG antibody. It is being increasingly utilized as off-label therapy of a variety of dermatological conditions including autoimmune mucocutaneous blistering diseases, autoimmune connective tissue diseases, Stevens–Johnson syndrome, toxic epidermal necrolysis, cutaneous vasculitides, skin infections and several other dermatoses, such as chronic urticaria, atopic dermatitis, pyoderma gangrenosum, scleromyxedema. Randomized trails are generally lacking. IVIg is a relatively safe and well-tolerated therapy inducing and maintaining a prolonged clinical remission, and has a corticosteroid-sparing effect. The mechanism of action of IVIg is multifactorial and includes: (1) reduction of autoantibody concentration, (2) modulation of cytokine production and (3) prevention of keratinocyte apoptosis. Normal degradation and removal from the body of all kinds of IgG antibodies after IVIg infusion results in a selective decrease of relative titer of pathogenic antibodies, because the level of normal antibodies is maintained by those present in the IVIg preparation. To prevent a “rebound” effect resulting from the negative feedback stimulation of B cells, IVIg should be combined with a cytotoxic immunosuppressive drug.

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Corresponding author

Correspondence to Sergei A. Grando MD, PhD, DSc .

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Questions

Questions

  1. 1.

    How is IVIg therapy given?

    1. A.

      Intravenously over several hours, gradually increasing the rate of infusion up to 200 ml/h

    2. B.

      Daily for 2–5 days. Usually at 400 mg/kg/day up to 2 g/kg per month

    3. C.

      Cycles can be repeated in 2–4 weeks

    4. D.

      Multiple cycles are usually required: from 3–5 to 30–50 and more

    5. E.

      All of the above

    6. F.

      None of the above

  2. 2.

    IVIg can be used in pregnancy.

    1. A.

      True

    2. B.

      False

  3. 3.

    What affects the safety of IVIg therapy?

    1. A.

      IgA content

    2. B.

      Concentration

    3. C.

      Sugar content

    4. D.

      Frequency and administration rate.

    5. E.

      All of the above

    6. F.

      None of the above

  4. 4.

    IVIg can be made to work better by combining it with:

    1. A.

      systemic corticosteroids

    2. B.

      topical corticosteroids

    3. C.

      cytotoxic immunosuppressors

    4. D.

      antibiotics

    5. E.

      multivitamins

Answers

  1. 1.

    E

  2. 2.

    A

  3. 3.

    E

  4. 4.

    C

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Mannering, I.K., Yu, Y., Grando, S.A. (2017). Intravenous Immunoglobulin: Dermatologic Uses and Mechanisms of Action. In: Gaspari, A., Tyring, S., Kaplan, D. (eds) Clinical and Basic Immunodermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-29785-9_50

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