Update on the treatment of Kawasaki disease in childhood.

Intravenous immunoglobulin (IVIG) treatment for Kawasaki disease (KD), first discovered almost 20 years ago, dramatically changed the management and prognosis of the condition. Although standard Japanese Ministry of Health criteria suggest that current treatment is more than 95% effective at preventing coronary artery changes, echocardiographic measurements adjusted for body size, imply a far higher incidence of coronary artery dilitation despite prompt therapy. If one also considers data on chronic alterations in endothelial function after KD, then more effective approaches to the management of acute and recurrent KD are needed. A variety of possible adjunct therapies--most notably high-dose corticosteroids--currently are being studied to determine whether better long-term outcomes may be achieved than with IVIG alone.