[PAGID] IVIG or not?

[Church, Joseph]

I would re-check polysaccharide antibodies.  If he is not losing protein
from his gut and with the history and IgG of <300, I would probably
begin replacement therapy.

Joe Church

 

________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Kobrynski, Lisa
Sent: Wednesday, April 28, 2010 11:38 AM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] IVIG or not?

 

I wanted to get some opinions on whether most people would start IVIG or
not on this child.

An 11 yr old boy with asthma who had several pneumonias (CXR positive)
since 2006.  He has GERD, no aspiration, chest CT unremarkeable.  He was
on antibiotic prophylaxis with azithromycin (MWF) and has been well for
2 winters.  Initial IgG was a little low 455, but has dropped witheach
measurement to 287.  Specific antibody titers are protective to protein
and polysaccharide antigens.  Flow is normal, B cell panel normal.  No
other infections.

 

I waited to see what his IgG would do since he was well, but at this
point he is not turning around.

So, who would go ahead and start IVIG now?  Any additional tests to
consider?  

 

Thanks

Lisa

 

Lisa Kobrynski, MD, MPH

Associate Professor of Pediatrics

Section, Allergy/Immunology

 

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