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SHORTAGE OF IV IMMUNOGLOBULIN
treatment with either azelastine nasal spray monotherapy or the combination of loratadine tablets plus beclomethasone nasal spray. A secondary variable was a subjective patient assessment of improvement at the end of the treatment period. For those patients reaching their primary efficacy variable, the distribution of patients reporting improvement as either “much better” or “a little better” across the three studies for each treatment arm is seen in the table above. As you can see, there is essentially no difference between the percentages of patients in each treatment group who reported improvement as either “much better” or “a little better” at the end of the study, and when all patients with any improvement (“much better” ⫹ “a little better”) in both groups are combined, the groups are virtually
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identical, as reported in the June 1999 publication. WILLIAM E BERGER, MD MISSION VIEJO, CALIFORNIA SHORTAGE OF IV IMMUNOGLOBULIN To the Editor: Dr. Milgrom’s fine guest editorial (Ann Allergy, Asthma and Immunology 1998;81:97–100) concerning the intravenous immunoglobulin shortage neglected an important reason for the current shortage—the increased use of IVIG for off-label indications such as bronchial asthma, infantile autism, recurrent abortion, and chronic fatigue syndrome.1 In these and many other diseases of unknown cause, large doses of IVIG are used by certain phy-
sicians, despite lack of substantial proof of clinical efficacy.1 The Immune Deficiency Foundation believes that up to 50% of the IVIG administered in the USA is used for off-label indications. If these uses were curtailed there could be sufficient IVIG for patients with proven need for the product and considerable cost savings to the patients or their insurers. E RICHARD STIEHM, MD Professor of Pediatrics Chief, Division of Allergy/Immunology/Rheumatology UCLA Department of Pediatrics UCLA School of Medicine Los Angeles, California REFERENCES 1. Stiehm ER. Appropriate therapeutic use of immunoglobulin. Transfusion Med Rev. 1996;10:203–221.
ANNALS OF ALLERGY, ASTHMA, & IMMUNOLOGY
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identical, as reported in the June 1999 publication. WILLIAM E BERGER, MD MISSION VIEJO, CALIFORNIA SHORTAGE OF IV IMMUNOGLOBULIN To the Editor: Dr. Milgrom’s fine guest editorial (Ann Allergy, Asthma and Immunology 1998;81:97–100) concerning the intravenous immunoglobulin shortage neglected an important reason for the current shortage—the increased use of IVIG for off-label indications such as bronchial asthma, infantile autism, recurrent abortion, and chronic fatigue syndrome.1 In these and many other diseases of unknown cause, large doses of IVIG are used by certain phy-
sicians, despite lack of substantial proof of clinical efficacy.1 The Immune Deficiency Foundation believes that up to 50% of the IVIG administered in the USA is used for off-label indications. If these uses were curtailed there could be sufficient IVIG for patients with proven need for the product and considerable cost savings to the patients or their insurers. E RICHARD STIEHM, MD Professor of Pediatrics Chief, Division of Allergy/Immunology/Rheumatology UCLA Department of Pediatrics UCLA School of Medicine Los Angeles, California REFERENCES 1. Stiehm ER. Appropriate therapeutic use of immunoglobulin. Transfusion Med Rev. 1996;10:203–221.
ANNALS OF ALLERGY, ASTHMA, & IMMUNOLOGY