Airway inflammation plays a significant role in the pathogenesis of asthma. Glucocorticoids remain a mainstay of anti-inflammatory therapy and the majority of asthmatics respond favorably to these drugs. However, some patients are less responsive to the drugs, often necessitating large oral doses for limited control of symptoms. A significant proportion of these patients derive from inner city minorities. Intravenous gammaglobulin therapy has been reported to have steroid-sparing effects in severe steroid-dependent asthma. The overall goals of this pilot study are to determine whether IVIG therapy results in improved steroid responsiveness. We will determine if IVIG increases steroid sensitivity using an ex vivo mitogen-induced proliferation assay and glucocorticoid receptor binding assay. Serum markers of inflammation (ECP and soluble IL-2 receptor levels) will be monitored in parallel. We predict that IVIG will enhance glucocorticoid sensitivity in inner-city minorities with severe asthma. This enhanced sensitivity will be associated with reduced inflammation and immune activation, and result in significant reductions in oral steroid requirements.
| Spahn, J D; Leung, D Y; Chan, M T et al. (1999) Mechanisms of glucocorticoid reduction in asthmatic subjects treated with intravenous immunoglobulin. J Allergy Clin Immunol 103:421-6 |
