In reply

We appreciate the comments by Collin, Marshall, and Heagerty regarding our article, which found a marked reduction in mortality associated with the use of IVIG for patients with TEN. We disagree with the idea that the use of the predictive model, SCORTEN, may be limited by factors such as patient ethnicity, etiology, and local management strategies and thus limit the significance of our findings. While ethnicity and etiology were not 2 of the 23 variables used in the development of SCORTEN¹ and it is possible that differences in these parameters might account for differences in mortality, data suggest this is not the case. Other investigators from various geographic locations with varying ethnic populations and presumably varied etiologies (offending medication) have found IVIG useful in patients with TEN, including the first report by Viard et al² and the largest series published (in the ARCHIVES) of 48 patients from 14 centers in Europe and the Untied States.³ Our study was the first to find benefit using the comparison of predicted mortality using SCORTEN. In addition, SCORTEN has been validated, and it is considered to be a useful tool, with universal applicability. While true management strategies are important for survival in patients with TEN, we presented data that our TEN patients treated with IVIG had a significantly lower mortality rate (6.25%) than a comparable historic group of TEN patients treated by us at our institution prior to the use of IVIG (29%).⁴