Child Health/Kawasaki disease treatment

Kawasaki disease therapy (IVIG + aspirin)

also: IVIG · intravenous immunoglobulin · Kawasaki

Overview

The treatment of Kawasaki disease — IV immunoglobulin plus aspirin — aimed at preventing the coronary artery aneurysms that define its danger.

Mechanism

IVIG provides a poorly-understood broad immunomodulatory/anti-inflammatory effect that reduces coronary aneurysm risk. Aspirin: high-dose for anti-inflammatory effect during the acute febrile phase, then low-dose for its antiplatelet effect while coronary status is assessed.

Indications

Kawasaki disease (ideally within 10 days of fever onset)

Adverse effects

IVIG: infusion reactions (fever, chills), headache/aseptic meningitiscommon

IVIG: rare thrombosis, renal impairment, haemolysisserious

Aspirin effects (see paediatric aspirin card)common

Cautions & contraindications

IgA deficiency (IVIG — anaphylaxis risk)all

Defer/adjust live vaccines (MMR) ~11 months after IVIGpaediatric

IVIG antibodies blunt the vaccine response.

Interactions

IVIG impairs live vaccine response

Monitoring & kinetics

Echocardiography for coronary artery aneurysms (diagnosis + follow-up),Response of fever to IVIG

IVIG as a single infusion; aspirin oral (high → low dose).

Choosing it

true

Source: BNF for Children — Immunoglobulins · RCPCH — Kawasaki disease