ARI Publication 40 – 2013 Version

Immune System Regulation

Rationale: Several studies have found abnormal immune function in autism, generally with shift
to Th-2, and some evidence for auto-immunity.

Molloy et al./ Elevated cytokine levels in children with autism spectrum disorder, J. Neuroimmunol 172
(2006) 198-205.

Testing: One standard test (available from any medical laboratory) is a measurement of total
immunoglobulins (antibodies) and their subclasses. Decreased levels of IgG or subclasses of IgG
provide evidence of immunodeficiency.

Treatments: More research on effective treatments for normalizing the immune system in
children with autism is needed. If lab testing reveals abnormal immune function, current possible
treatments include intra-venous immunoglobulins (!VIG), Actos (pioglitazone), and low-dose
naltrexone.

Research:
IVIG: Gupta et al., found !VIG benefited 4 of 10 children, with 1 case of marked improvement.
This is a very expensive treatment, as the immunoglobulins (antibodies) need to be collected from
hundreds or thousands of human donors, but it may be covered by insurance if there is evidence of
immune deficiency.

Gupta et al./ Treatment ofchildren with autism with intravenous immunoglobulin. J Child Neural. 1999
Mar;14{3):203-5.

Twenty-six autistic children received intravenous gamma globulin (!VIG) every 4 weeks for 6
months at a dose of 400mg/Kg. Aberrant behaviors, speech, hyperactivity, inappropriate stims and
social interactions significantly improved. However 22 of the 26 children regressed within 4 months
after discontinuing !VIG. Anecdotal reports from clinicians suggest that 12 months or longer
therapy is needed for long-term benefits.

Boris m/ Goldblatt A/ Edelson SM; Improvement in children with autism treated with intravenous gamma
globulin. Journal ofNutritional & Environmental Medicine/ Dec 2005; 15(4): 169-176.

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome, formerly known as PANDAS)
is the term used to describe a subset of children and adolescents who have sudden-onset Obsessive
Compulsive Disorder (OCD) and/or tic disorders, and in whom symptoms worsen following
infections (in the case of streptococcus, the term “PANDAS” is still used). The OCD and tic
symptoms are accompanied by a variety of other neuropsychiatric symptoms, including separation
anxiety, “anxiety attacks,” irritability, extreme mood swings, temper tantrums, and immature
behaviors (like talking “baby talk”), hyperactivity, problems with attention and concentration,
handwriting changes, and problems with math, reading and other school subjects. It is present in
some children with ASD. The diagnosis is made from symptoms alone; in the case of PANDAS,
which comes from strep, elevated ASO (Antistreptolysin Antibodies) and/or antiDNAse antibody
levels can be helpful; if the throat culture is positive, a single course of antibiotics will usually get rid
of the strep infection and allow the PANDAS symptoms to subside. A treatment for both PANS and
PANDAS is !VIG. This therapy is covered by many insurance carriers and may be an additional
method for children with ASD to be covered for !VIG. Also, prophylactic antibiotic therapy is
sometimes recommended to prevent further strep infections. For more information, see
http://intramural.nimh.nih.gov/pdn/web.htm

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