[Frontiers in Bioscience 1, e55-64, August 1,1996]
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IMMUNOGLOBULIN THERAPY IN KAWASAKI SYNDROME AND RSV PROPHYLAXIS

H. Cody Meissner, M.D.1, and Donald Y.M. Leung, M.D., Ph.D.2

1 Department of Pediatrics, Floating Hospital for Children at New England Medical Center; Tufts University School of Medicine, Boston, MA 02111;

2 Department of Pediatrics; The National Jewish Center for Immunology and Respiratory Medicine; Denver, CO 80262

2. INTRODUCTION

Since the end of the 19th century, immune serum has been used in the treatment of a number of toxin mediated infectious diseases including diphtheria, scarlet fever, botulism, pertussis, gas gangrene and tetanus. In addition to inactivation of specific toxins, gamma globulins are also used to enhance biologic function against various microbes by complement mediated lysis, opsonization or neutralization. More recently, immunomodulatory functions of intravenous preparations of immunoglobulins (IVIG) have been described which include alterations in cytokine production (1), modulation of T cell function in vitro and in vivo (2,3), inhibition of antibody secretion in vitro (4), increase in natural killer cell activity (5) and increase in antibody-dependent cell cytotoxicity (5). A recently established activity of IVIG is neutralization of staphylococcal superantigen activity (6). In this report, we will review the potential mechanisms of action of IVIG in the treatment of Kawasaki Syndrome (KS) and the experience with IVIG in the prophylaxis of RSV infections. KS represents a vasculitis which may respond to gamma globulin therapy via the neutralization of bacterial toxin(s). Although other mechanisms are likely to be demonstrated as well in both settings, IVIG prophylaxis against RSV infection appears to work primarily through viral neutralization.

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