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Background Prednisolone ( PSL) has been suggested to be useful for the treatment of Kawasaki disease ( KD) resistant to i.v. immunoglobulin ( IVIG), but much remains to be elucidated regarding its use. Methods A total of 1087 subjects were involved in a two-study multicenter prospective investigation of the effects of acute phase therapy on IVIG-resistant KD. Subjects resistant to the first dose of IVIG were classified into high (≥10 mg/dL) and low (<10 mg/dL) serum C-reactive protein ( CRP) groups after the first dose of IVIG. Results In the first study, the efficacy of the second dose of IVIG in the high CRP group was significantly lower than in the low CRP group (47.8% vs 76.8%, P < 0.005). In the second study, PSL was co-administered with the second dose of IVIG to the high CRP patients (intensified regimen). The efficacy of the intensified regimen was similar to that of the second dose of IVIG in the low CRP group (79.4% vs 83.3%). Although the difference in the incidence of persistent coronary artery lesions ( CAL) between the high and low CRP groups was significant in the first study (19.6% vs 3.0%, P < 0.005), it was not significant in the second study (8.8% vs 2.4%). Conclusions The targeted use of PSL with the second dose of IVIG in KD patients resistant to the first dose of IVIG and who are predicted to be resistant to the second dose of IVIG, appears to be effective. [ABSTRACT FROM AUTHOR]

Background: Among the casein components, αs-casein (αs-CAS) is considered the major allergen in Japan, and there are very few reports on the allergenicity of β-casein (β-CAS). In this study, we compared the allergenicity of β-CAS with that of αs-CAS in Japanese children with cow milk allergy (CMA)., Method: The allergenicity of αs-CAS and β-CAS in 29 CMA patients and 11 control subjects was assessed using the basophil activation test (BAT). The accuracy of the BAT to distinguish the patients with CMA from the control subjects was estimated using a receiver operating characteristic (ROC) analysis and was expressed as the area under the curve (AUC)., Results: BAT results for CM were positive in 93.1% of the CMA patients. The results of the β-CAS-BAT and αs-CAS-BAT were found to be positive in 86.2% and 69.0% of the CMA patients, respectively, however, the difference was not significant. The AUC for the β-CAS-BAT was 0.893, which was not significantly different from that for the αs-CAS-BAT (0.859)., Conclusions: These results suggest that the allergenicities of β-CAS and αs-CAS are similar in Japanese patients with CMA.