HH Kwon and KH Kim all had marked improvement. The remission persisted over 6 months without relapse. Other immunologic mar- kers, including ICAM-1, ELAM-1, ECP, and IL-2R de- creased accordingly. Noh and Lee8 reported that patients with recalcitrant AD showed clinical improvement to variable degrees after receiving a single cycle of relatively low-dose IVIG (patients weighing ＜30 kg were treated with 500 mg/kg of IVIG and those weighing ＞30 kg were treated with 15 g of IVIG) over a 3-week follow-up period. The only case which did not show clinical improvement after receiving IVIG (1 g/kg) was an 8-month-old boy with Wiskott-Aldrich syndrome9. In our case, the patient received 3 cycles of IVIG (2 g/kg) and had dramatic clinical improvement without recur- rence for 8 months and without notable side effects. Our treatment regimen was similar to that in the study of Huang et al.7, while the immunologic parameters did not change significantly before and after IVIG treatments. Comparing with previous trials, our patient showed a more pronounced clinical response and maintained a longer prolonged remission state. Although the specific dosage regimens and follow-up periods were different in the above trials and our case, we can draw the following conclusions tentatively: 1) a few cycles of IVIG mono- therapy is clinically effective in pediatric patients with refractory AD, with an early clinical response and prol- onged remission; 2) no significant side effects were ob- served in the trials; 3) immunologic parameters reflected clinical improvement in some cases. While both reporting bias for successful outcomes and the small number of total patients in clinical trials should be taken into account carefully, IVIG monotherapy is considered especially useful for children with severe AD. This could be expl- ained by the fact that the immunoregulatory function of IVIG is more profound in the relatively immature immune system of children, although further research is required for confirmation. Compared with other immunosuppressants for recalcitrant AD, the safety profile of IVIG appears to be outstanding. Most of the reported side effects are mild and self- limiting15 including headache, low grade fever, nausea, vomiting and flushing. Side effects of IVIG vary from individual-to-individual and often occur 30∼60 min after the onset of the infusion. These side effects are usually overcome by reducing the infusion rate and administering antihistamines or non-steroidal anti-inflammatory drugs before beginning the infusion. In our case, the patient had headaches, nausea, and fevers immediately after the start of all three infusions, which resolved after slowing the infusion rate and taking oral antihistamines. In very rare cases, severe side effects, such as aseptic meningitis, 68 Ann Dermatol stroke, and anaphylactic shock, might occur during the infusion, especially for patients with underlying risk fac- tors. Therefore, performing a medical work-up is impor- tant and adverse effects can be minimized by following the guidelines in the physician’s checklist16. About po- ssible mechanisms of IVIG treatment, modulation of T helper 1 (Th1) and Th2 cytokine production is suggested as one of the possible mechanisms. Intracellular IL-4 decreases after infusing high-dose IVIG17. However, consi- dering the general conversion of cytokine profiles from Th2 to Th118 in late-stage AD, other mechanisms, such as recirculation of skin homing T cells and blockade of provoking antigens should also be considered. In conclusion, we herein report a case in which IVIG monotherapy was very helpful in treating resistant AD in a child, without significant side effects. 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