Patients with severe
asthma pose a dilemma to the physician since the treatment they need, namely high doses of oral
steroids, has serious side effects, especially among the pediatric population. Deficiency in one or more of the
IgG subclasses has been associated with abnormal pulmonary function, as well as with recurrent sinopulmonary
infections in adults and children. In the last years attention has been focused on
alternative therapies for these patients. One of these alternatives is the treatment with
intravenous immunoglobulin (
IVIG). We report an 11-year-old boy with severe
asthma since the age of two years and multiple hospital admissions due to
asthmatic crisis even more frequent and severe, to the point of needing, in the last year, daily treatment with high doses of oral
steroids (20 mg). During six months the patient was given high doses of
intravenous immunoglobulin. After one month of treatment a clinical and spirometric improvement was apparent allowing to taper down the oral
steroids until their complete substitution by inhaled
budesonide (1,600 microg/day). The only side effects noted were severe
headaches after gammaglobulin infusions which responded well to oral
paracetamol. This improvement was sustained throughout the treatment period, but few weeks after the
IVIG was suspended the clinical and spirometric parameters started to worsen again.