High-dose
intravenous immunoglobulin is being used increasingly as a new therapeutic approach towards various
autoimmune diseases, yielding encouraging results predominantly in
idiopathic thrombocytopenic purpura (
ITP). A marked initial increase of the platelet count has been observed in the majority of patients with acute and chronic
ITP alike after high-dose
immunoglobulin. In contrast to acute
ITP, where full or partial remissions have been achieved in nearly all cases, long-term results reached in chronic
ITP, where lasting increases of platelet counts have been observed predominantly in splenectomized patients, have proved to be less favourable. Correspondingly, several cases of other forms of
autoimmune thrombocytopenia and
neutropenia successfully treated by high-dose
immunoglobulin have been reported. We contribute our own experience in 4 patients with
myasthenia gravis, where administration of 7S-immunoglobulin but not of 5S-immunoglobulin was followed by both a clinical remission as well as a decrease of specific
autoantibody concentration. While several mechanisms of action of high-dose
immunoglobulin are discussed, there is evidence for an immunosuppressive effect and for the
Fc-fragment dependency of the therapeutic efficacy. Although high-dose
immunoglobulin has proved to be a promising therapeutic option especially in
ITP, indications will have to be defined yet by further investigations and may be restricted to emergency and refractory cases.