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Seasonality of i.v. immunoglobulin responsiveness in Kawasaki disease
Author(s) -
Kido Shinji,
Ae Ryusuke,
Kosami Koki,
Matsubara Yuri,
Makino Nobuko,
Sasahara Teppei,
Kuwabara Masanari,
Aoyama Yasuko,
Yashiro Mayumi,
Yanagawa Hiroshi,
Nakamura Yosikazu
Publication year - 2019
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13863
Subject(s) - medicine , kawasaki disease , seasonality , statistics , mathematics , artery
Background Evidence suggests that seasonal variation in the onset of Kawasaki disease (KD) exists worldwide. Whether a seasonal component to successful i.v. immunoglobulin (IVIG) therapy exists in KD‐positive children, however, is unknown. We addressed this question by focusing on patients with primary onset KD who were non‐responsive to IVIG treatment, in the large nationwide Japanese KD survey datasets from 2009 to 2016. Methods In these datasets, the IVIG therapy non‐responders were defined as patients whose fever persisted ≥24 h or recurred ≤24 h after the end of the initial IVIG treatment (dosage, 2,000 mg/kg). Those who successfully responded to this treatment were defined as IVIG responders. The consecutive monthly trend of the proportion of IVIG non‐responders was analyzed throughout the study period to investigate seasonal periodicity on Fourier analysis, and the monthly distributions of non‐responders and responders were compared. Results From a total of 113 691 KD‐positive patients, 15.7% were IVIG non‐responders, and 61% were male. The proportion of non‐responders increased across each calendar year with fluctuation, and Fourier analysis indicated seasonal periodicity. The seasonality effect differed between responders and non‐responders, with the proportion of responders tending to increase in autumn through winter, while the non‐responders showed a decreasing trend in autumn. The seasonality effect tended to differ by sex. Conclusions The results indicate that the currently unknown etiological agents of KD might differ between IVIG responders and non‐responders. In addition, immune reactivity against such agents possibly differs by sex in the IVIG non‐responders.