難治性中耳炎児に対するIgG2サブクラス抗体価測定の意義と免疫グロブリン製剤大量療法への提案

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  • Significance of the IgG2 Antibody Subclass in Intractable Pediatric Otitis Media and Proposal for High-Dose Immunoglobulin Preparation Therapy

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<p>Immunodeficiency in young children is one of the risk factors for intractable otitis media. In January 2015 a clinical IgG2 antibody titer test became covered by Japanese national health insurance, and it became possible to assess the immune system of pediatric patients. We have performed immunologic tests, including IgG2 antibody titer tests, on 30 intractable otitis media patients 0–2 years of age who were examined in our hospital since November 2014, and the results showed that 5 of them had low IgG2 titers. After treating 3 of them for a year, we concluded that they had indications for high-dose intravenous immunoglobulin (IVIG) therapy, and we performed the intravenous therapy in the pediatric department of a general hospital. When we did so, problems before and after treatment from the standpoint of physicians in private practice came to light, including deciding the criteria for indications, explaining about it to the parents/guardians to seek their understanding, performing as yet unperformed live vaccine immunizations and adjusting their timing, being in close touch with pediatricians on the hospital staff who perform the IVIG therapy, etc. </p>

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