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An Asthma Antibody?
Nov. 16, 1999 (Los Angeles) - - Asthma sufferers who want to reduce their dependence on high-dose steroids to treat serious attacks may find a "shot" of hope in a new study. A group of researchers found that treating severe asthma with an injection of immunoglobulin (IVIG) -- an antibody -- may reduce the need for high-dose steroids. Their study findings were reported in a recent issue of the Journal of Allergy and Clinical Immunology.
"This is a confirmation of what we have been [reporting] for the last 10 years," Erwin Gelfand, MD, tells WebMD in an interview seeking an independent review of the study. Gelfand is chairman of pediatrics, National Jewish Medical & Research Center, Denver.
However, researchers who reviewed the study point to a downside: Besides being hard to obtain and expensive, IVIG doesn?t work for everyone. Another expert not involved in the study, Robert L. Roberts, MD, PhD, warns that IVIG is rare and expensive -- and that not all patients respond to it. Roberts is associate professor of pediatrics at the UCLA School of Medicine, Los Angeles.
The study researchers, led by Luis M. Salmun, MD, of Harvard Medical School, Boston, note that the frequent and often heavy use of steroids for treating severe asthma can put patients at high risk for side effects. Those side effects may include slowed growth, cataracts, high blood pressure, diabetes, and bone weakness, among others.
The study involved 38 patients with severe asthma who required regular and high doses of steroids to keep their asthma under control. The patients were gradually weaned from steroids as they began receiving the IVIG. Among the participants, those who had been very dependent on steroid products such as Azmacort, Veclovent, and Vanceril -- patients who had taken doses as high as 2,000 mg or more during serious attacks in the year before the study started -- had the best results when IVIG was used in place of steroids. It is worth noting, however, that some patients who received a non-active pill (placebo) instead of IVIG were also able to reduce their steroid dependency.
The way that IVIG reduces asthma patients' need for steroids is not known, but Gelfand says it may slow the body?s production of cytokines -- proteins that help regulate the immune response -- and reduce the inflammation that constricts the airways in persons with asthma. "Those two effects may combine to increase the patient's steroid sensitivity -- in essence, resetting the thermostat so it is lower," he says.
If further studies produce the same results, Gelfand tells WebMD, IVIG may prove effective in treating many other diseases that are steroid dependent or conditions characterized by chronic inflammation. That would include diseases such as lupus, transplantation rejection, Crohn's disease, and ulcerative colitis. Currently, IVIG often is prescribed for diseases characterized by blood disorders such as thrombocytopenia or neutropenia.
"IVIG is expensive because it is a limited resource: It is processed from human serum and requires extensive screening," Roberts says. He adds that some patients taking IVIG experience severe side effects, including aseptic meningitis and renal toxicity.
Gelfand recommends that primary care physicians enlist the help of a specialist when treating people with severe asthma. "If patients require a lot of steroids, or increasing doses of steroids to control their asthma, there's a problem," he says. In such cases, the patient?s primary physician should also work with a specialist to determine why the asthma is worsening, he says.
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