Abstract
Over the past two decades, intravenous immunoglobulin (IVIG) therapy has become established as a standard therapy for Kawasaki disease, but still has some problems. First, there are some cases resistant to initial high dose IVIG therapy. Although such cases are often successfully treated with additional IVIG therapy, a few cases are still resistant. Second, IVIG is costly and not without risk of adverse reactions, including transmission of infectious agents. Considering these problems, we think that an alternative therapeutic approach to Kawasaki disease is needed. Kawasaki disease is an inflammatory disease that causes panvasculitis, including coronary artery. Polymorphonucleocytosis in the early stage of the illness suggests the implication of neutrophils in the pathogenesis of Kawasaki disease. Urinary trypsin inhibitor (ulinastatin, UTI) is derived from human urine, and inhibits the neutrophil elastase activity. Ulinastatin has been shown to have a clinical application for the treatment of inflammatory diseases such as pancreatitis, systemic inflammatory response syndrome, and acute respiratory distress syndrome. We conducted an original therapeutical regimen using ulinastatin for Kawasaki disease. From March 1999 to June 2001, sixty cases were received ulinastatin therapy, forty-one cases (68 %) responded to ulinastatin alone, while nineteen cases (32 %) needed additional IVIG therapy. Only two cases (2%) showed an ectatic coronary changes (3.5 mm and 4.8 mm in diameter, respectively) of the left anterior descending branch. We concluded that our new therapy for Kawasaki disease using ulinastatin is at least as effective as IVIG therapy and less expensive and less risky.
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Yoshida, S., Ai, Y., Imai, K. et al. A New Therapy for Kawasaki Disease -Effectiveness of Ulinastatin Therapy-. Pediatr Res 53, 182 (2003). https://doi.org/10.1203/00006450-200301000-00170
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DOI: https://doi.org/10.1203/00006450-200301000-00170