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Anti-inflammatory corticosteroid therapy is highly effective, however, the long term adverse effects may be devastating for patients with severe asthma. Intravenous immunoglobulin (IVIG) is known to have immunomodulatory effects, and in a few clinical trials has been shown to have potential benefit as a steroid-sparing agent in asthma patients requiring high doses of corticosteroids. This study assessed the efficacy of high-dose IVIG in reducing the steroid requirement and subsequently improving the pulmonary function, symptomatology, and quality of life in patients with severe steroid-dependent asthma. Six immunocompetent, steroid-dependent patients were enrolled in an open-label trial of IVIG given as six monthly infusions of 2 g/kg per dose. Five patients completed the study. Of these, four showed a significant reduction in oral corticosteroid requirement while being treated with IVIG. The mean reduction was 10.1 mg/d (p = 0.02), which was an almost 50% decrease in corticosteroid requirement. Two patie...

Background Because of potential toxicities of inhaled corticosteroid (ICS) use in pediatric asthma, alternative or steroid-sparing therapy is desirable. There are no previous studies evaluating montelukast's steroid-sparing effects in children with asthma. Objective To evaluate whether (1) montelukast as add-on therapy improves asthma symptom control and (2) montelukast provides steroid-sparing effects in children with asthma treated with low to moderate doses of ICS therapy. Methods In a double-blind, placebo-controlled trial, 36 children ages 6 to 14 years with symptomatic asthma maintained on a stable low to moderate dose of ICSs were randomly assigned to receive montelukast or matching placebo for 24 weeks after a run-in period of 2 weeks (period I). During the trial, subjects kept daily asthma diary cards and monthly spirometry was performed. After a 4 week add-on period (period II), the subjects completed a 20-week (period III) ICS tapering period based on a predetermined protocol. Results In period II, the difference in the number of rescue-free days was significantly higher in the montelukast group ( P = 0.0001), and the number of rescue-free days per week was also significantly higher in montelukast-treated subjects compared with placebo subjects ( P = 0.002). In period III, the percentage reduction in ICS dose was not significant between montelukast and placebo ( P = 0.10), but the montelukast group experienced an average 17% decrease in ICS dose and the control group experienced an average 64% increase in ICS dose. Conclusions Montelukast treatment significantly increased the number of rescue-free days in symptomatic children with asthma.