Immunosuppressive and/or immunomodulatory medications are commonly used in children with inflammatory bowel disease (IBD). These medications can increase the risk of infections. Diarrheal illnesses are usually self-limited, but can result in chronic diarrhea in immunocompromised children. There are many reports about the use of oral administration of human serum immunoglobulins (oral IG) in non IBD immunocompromised children with diarrheal illness, but there is paucity of data about the role of Oral IG in managing diarrheal illness in children with IBD. The aim of this study is to assess the efficacy of oral IG in immunocompromised IBD children with diarrheal illness.Methods:
A retrospective cohort review of the Mayo Clinic electronic medical records from January 2000 to March 2016 was performed on children <18 years of age with a diagnosis of IBD who received oral IG for a diarrheal illness. Response to therapy was defined as 50% reduction in stool output. Age, time to response and length of hospitalization were reported as mean ± SD.Results:
Ten children were identified (5 males); mean age at the time of treatment was (8.6 ± 6.38) years. Of those, 4 had Crohn's disease, 2 ulcerative colitis, 2 IBD unclassified, 1 eosinophilic colitis and 1 collagenous colitis. All these patients except for one patient were on immunosuppressive medication (5 children on oral glucocorticosteroid and 4 on anti TNF) including 3 children who were on combined therapy. All patients required hospitalization except for one patient who received oral IG as an outpatient. Five children were found to have Rotavirus, 2 Norovirus, and 2 Adenovirus. One patient had a negative stool study, but was treated because the clinical presentation was highly suggestive of infection. All children received the same dose of oral IG at 300 mg/kg per dose daily × 3 doses. Mean length of diarrhea prior to therapy was 28 days range 2 to 90. Eight children (80%) responded to treatment. The mean time to response was (3 ± 1.24) days. Length of hospitalization was (10.11 ± 8.66) days. The child with the longest hospitalization required prolonged stay for other medical reasons.Conclusions:
Oral administration of human serum immunoglobulin in children with IBD presenting with diarrheal illness appeared helpful in the majority of these patients. Prospective controlled studies should be considered in children with IBD and infectious diarrheal illness.