Abstract
Toxic epidermal necrolysis (TEN) is a rare, life-threatening hypersensitivity reaction to certain medications. Keratinocytes affected by TEN have been found to undergo Fas–FasL-mediated apoptosis. Intravenous immunoglobulin (IVIG) has been shown to inhibit this interaction. However, conflicting reports have led to controversy regarding the use and dosage of IVIG for the treatment of TEN and Stevens–Johnson Syndrome (SJS). The aim of this article is to analyze both our experience and the published literature regarding IVIG treatment of adult patients with SJS and TEN to determine whether a dose response exists. We searched Medline for all studies involving the use of IVIG for TEN or SJS. We categorized total IVIG dose and used Cochran-Armitage Trend Test to examine whether high doses were associated with improved survival. We also performed multivariate logistic regression analysis to evaluate total IVIG dose and mortality after controlling for age and body surface area. There are several limitations to this method, such as publication bias, heterogeneous diagnostic definitions and methods of each study, and the exclusion of two of the studies owing to lack of individual IVIG dosing data. Logistics regression results showed that, with each 1 g/kg increase in IVIG dose, there was a 4.2-fold increase in TEN patient survival, which was statistically significant. Patients treated with high doses of IVIG had a significantly lower mortality compared with those treated with lower doses of IVIG.