Use of Intravenous Immunoglobulin in Clinical Dermatology

148 Pages·2002·3.276 MB·English

by  Jolles Stephen

Intravenous Imunoglobulin in Dermatology
Intravenous
Immunoglobulin in
Dermatotogy
Edited by
STEPHEN JOLLES MSc PhD MRCP MRCPath
LRF FELLOW & HONORARY CONSULTANT IN
IMMUNOLOGY
& ALLERGY
NATIONAL INSTITUTE OF MEDICAL
RESEARCH
AND ROYAL HOSPITAL
LONDON
UK
LONDON AND NEW YORK
© 2003 Martin Dunitz, an imprint of the Taylor & Francis Group
First published in the United Kingdom in 2003 by
Martin Dunitz, an imprint of the Taylor & Francis Group, 11 New Fetter Lane,
London EC4P 4EE
Tel.: [phone]
Fax.: [phone]
E-mail: [email protected]
Website: http://www.dunitz.co.uk
This edition published in the Taylor & Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of
thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording,
or otherwise, without the prior permission of the publisher or in accordance with the provisions
of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting
limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London
W1P 0LP.
Although every effort has been made to ensure that all owners of copyright material have been
acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or
editions any omissions brought to our attention.
A CIP record for this book is available from the British Library.
ISBN 0-203-62705-9 Master e-book ISBN
ISBN 0-203-63089-0 (Adobe eReader Format)
ISBN 1 84184 136 6 (Print Edition)
Distributed in the USA by
Fulfilment Center
Taylor & Francis
10650 Tobben Drive
Independence, KY 41051, USA
Toll Free Tel.: [phone]
E-mail: [email protected]
Distributed in Canada by
Taylor & Francis
74 Rolark Drive
Scarborough, Ontario M1R 4G2, Canada
Toll Free Tel.: [phone]
E-mail: [email protected]
Distributed in the rest of the world by
Thomson Publishing Services
iv
Cheriton House
North Way
Andover, Hampshire SP10 5BE, UK
TeL: [phone]
E-mail: [email protected]
Composition by Wearset Ltd, Boldon, Tyne and Wear
Contents
Contributors vi
Preface viii
1 Intravenous immunoglobulins— mechanisms of action 1
Hans-Peter HartungBernd C Kieseier
2 The role of high-dose intravenous immunoglobulin in 19
dermatomyositis
Marinos C Dalakas
3 Chronic urticaria 29
Brigid F O’Donnell
4 Atopic dermatitis—role of hdIVIg 47
Samantha EismanMalcolm HA Rustin
5 Kawasaki disease 56
Andrew J CantLaura Jones
6 Toxic epidermal necrolysis 71
Nicholas M Craven
7 Intravenous immunoglobulin in the treatment of 85
scleromyxoedema, scleroderma, pyoderma gangrenosum and
pretibial myxoedema
Stephen Jolles
8 IVIg therapy in autoimmune mucocutaneous blistering diseases 98
A Razzaque AhmedNaveed Sami
9 Safety and tolerability of intravenous immunoglobulins 119
Turf D Martin
Index 134
Contributors
A Razzaque Ahmed MD
Department of Oral Medicine
Harvard School of Dental Medicine
Boston, MA
USA
Andrew J Cant
Paediatric Immunology & Infectious Diseases Unit
Newcastle General Hospital
Westgate Road
Newcastle upon Tyne
UK
Nicholas M Craven
Honorary Consultant Dermatologist
Dermatology Centre
Hope Hospital
Salford
Manchester
UK
Marinos C Dalakas MD
National Institutes of Neurological Disorders
and Stroke
National Institutes of Health
Bethesda, MD
USA
Samantha Eisman MBChB MRCP
Specialist Registrar in Dermatology
Royal Free Hospital
London
UK
Hans-Peter Hartung MD
Department of Neurology
Heinrich-Heine-University
vii
Düsseldorf
Germany
Laura Jones
Clinical Research Fellow
Child Health
Sir James Spence Institute
Royal Victoria Infirmary,
Newcastle upon Tyne
UK
Stephen Jolles PhD MRCP MRCPath
LRF Fellow & Honorary Consultant in
Immunology & Allergy
National Institute of Medical Research and
Royal Free Hospital
London
UK
Bernd C Kieseier MD
Department of Neurology
Heinrich-Heine-University
Düsseldorf
Germany
Turf D Martin
Genesis Medical Marketing Consultants, LLC
Sedalia, Missouri
USA
Brigid F O’Donnell MD MRCPI DCH
Consultant Dermatologist
The Children’s University Hospital
Temple Street, Dublin
Ireland
Malcolm HA Rustin MBChB FRCP
Consultant Dermatologist
Royal Free Hospital
London
UK
Naveed Sami MD
Department of Oral Medicine
Harvard School of Dental Medicine
Boston, MA
USA
Preface
The major clinical specialties using intravenous immunoglobulin (IVIg) have
been immunology, neurology and haematology. More recently, however, there
has been an increase in the dermatological use of high dose IVIg (hdIVIg). This
book is broadly based on a symposium held at the Dermatology 2000 meeting in
Vienna, Austria and aims to provide a critical summary of the current data
concerning the use of hdIVIg in the major dermatological conditions to which it
has been applied.
HdIVIg is already an established treatment in some of these conditions such as
Kawasaki disease and therapy resistant dermatomyositis, however the data in
many others is derived from small studies and case reports. There are very few
double-blind randomized studies of the use of hdIVIg in dermatological
disorders and it is becoming clear that a number of the conditions described in
this book have accrued sufficient evidence of benefit in smaller studies to warrant
similarly designed studies. These studies will need to address a number of
questions not only of efficacy but also which other agents should be chosen when
hdIVIg is used adjunctively, what is the mechanism of action and how long
should it be continued. Studies using IVIg in the treatment of inflammatory or
autoimmune disease have led to a better understanding of the pathogenic
mechanisms underlying these disorders and hence new potential treatment
modalities. The future may see genetically engineered components of IVIg such
as Fc or monoclonal antibodies used for specific indications. It is hoped that
readers find the book helpful in distilling the current evidence for the use of
hdIVIg in dermatological conditions as well as understanding its mechanism(s) of
action in these diseases.
Stephen Jolles
1
Intravenous immunoglobulins—
mechanisms of action
Hans-Peter Hartung and Bernd C Kieseier
ADCC: antibody-dependent cellular cytotoxicity; IFN: interferon; LFA:
lymphocyte function-associated antigen; MAC: membrane attack complex; MHC:
major histocompatibility complex
Intravenous immunoglobulins (IVIg) were initially used as a replacement therapy
in patients with hypogammaglobulinaemia. Fortuitously, in 1981 Imbach and
colleagues1 discovered that these preparations exhibited beneficial therapeutic
effects in idiopathic thrombocytopenic purpura. Since this observation, IVIg has
been tested at least experimentally in numerous disorders of presumed
autoimmune genesis. Although the complete spectrum of mechanisms of action
of IVIg is not yet completely understood, experimental and clinical studies have
elucidated a number of mechanisms by which IVIg may modify disease. The
following chapter aims to provide insight into the present status of knowledge on
mechanisms of action of IVIg, based on immunological concepts relevant in the
pathogenesis of immune-mediated disorders.
Immunoglobulins in the immune system
The immune system is an organization of cells and molecules with specialized
tasks in defending the organism from external agents, usually infectious but also
toxic. Moreover, the immune system plays a pivotal role in maintaining antigenic
homeostasis in the body.
Based on the formation of immunological memory, the immune system has
traditionally been divided into innate and adaptive systems, each of which
contains different cellular and molecular components and thus performs different
functions. The main distinction between these two systems lies in the mechanisms
and receptors used for immune recognition.2,3
The adaptive immune system is based on two classes of highly specialized
cells, T and B lymphocytes. Each of these cells expresses a single kind of
structurally unique receptor, resulting in a broad and extremely diverse repertoire
of antigen recognition.