Intravenous polyvalent immunoglobulins for autoimmune diseases in children

Therapeutic applications: Intravenous immunoglobulins (IgIV) are used are substitution therapy inimmunodeficiency states and for the their immunomodulation properties in certain autoimmune diseases. Use of IgIV is aimed at restoring or stimulating physiological mechanisms controlling autoimmune reactions. Mechanisms of action: The different mechanisms of action depend on the Fc fragment and/or variable regions of the Fab fragment. IgIVs can neutralize circulating pathogenic autoantibodies via the autoantibody-anti-idiotype interaction, They can also block macrophage Fc receptors in the spleen and modulate synthesis and secretion or proinflammatory cytokines. In the long term, igIV can restore physiological regulation of B cell, and probably T cell, repertoires. Indications: in pediatric patients, IgIV are mainly used for autoimmune disorders such as idiopathic thrombopenic purpura and Kawasaki's disease where they have proven efficacy. They are probably also effective in patients with chronic juvenile polyarthritis and other systemic diseases although controlled the rapeutic trials are lacking. IgIV can be helpful in reducing corticosteroid doses in corticodependent inflammatory diseases. Tolerance: Perfusions of IgIV are generally well tolerated in children except in case of constitutional IgA deficiency. Safety, notably protection against viral contamination, is guaranteed by rigorous preparation techniques. (C) 1998, Masson, Paris.