Autism Studies and Related Medical Conditions, January 2009 - TACA

improve autistic symptoms. Ten autistic children with immunologic abnormalities,
demonstrated on blood tests, were enrolled in this study. Their ages ranged from
4 to 17 years, with two girls and eight boys. Eight children (1 female and 7 male)
historically had undergone autistic regression. Intravenous immunoglobulin, 200
to 400 mg/kg, was administered every 6 weeks for an intended treatment
program of four infusions. In five children, there was no detectable change in
behavior during the treatment program. In four children, there was a mild
improvement noted in attention span and hyperactivity. In none of these children
did the parents feel that the improvement was sufficient to warrant further
continuation of the infusions beyond the termination of the program. Only in one
child was there a very significant improvement, with almost total amelioration of
autistic symptoms over the time period of the four infusions. Once the treatment
program was completed, this child gradually deteriorated over a 5-month time
period and fully reverted to his previous autistic state. In this treatment program,
five children had no response to intravenous immunoglobulin. In the four
children who showed mild improvements, those improvements may simply have
been due to nonspecific effects of physician intervention and parental
expectation (ie, placebo effect). However, in one child there was a very
significant amelioration of autistic symptoms. There were no distinguishing
historic or laboratory features in this child who improved. Given a positive
response rate of only 10% in this study, along with the high economic costs of
the immunologic evaluations and the intravenous immunoglobulin treatments,
the use of intravenous immunoglobulin to treat autistic children should be
undertaken only with great caution, and only under formal research protocols.
Plioplys, A. V. (2000). "Intravenous immunoglobulin treatment in autism." J Autism Dev
Disord 30(1): 73-4.
Robinson, P., D. Anderson, et al. (2007). "Evidence-based guidelines on the use of
intravenous immune globulin for hematologic and neurologic conditions." Transfus Med
Rev 21(2 Suppl 1): S3-8.
In Canada, intravenous immune globulin (IVIG) use has increased by 115% over
the past 7 to 8 years. Given this increased usage, Canadian Blood Services and
the National Advisory Committee on Blood and Blood Products for Canada
identified the need to develop and disseminate evidence-based guidelines to
facilitate appropriate IVIG use. As a result, guidelines for IVIG use in hematologic
and neurologic conditions have been developed and are published in this
supplement of Transfusion Medicine Reviews. This commentary provides a brief
description of the process used to develop these guidelines and includes a
summary of the recommendations for IVIG use in the various conditions
evaluated.
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