[PAGID] IVIG or not?

[Conley, Mary Ellen]

I don't think there is a perfect answer and every patient is different.  However, I have held off on patients like this who do well on prophylactic antibiotics - expecially since he has protective antibodies (and even more so if the family is resistent to the idea of gammaglobulin).  If his IgA and IgM are normal, I would check for giardia as a cause of low IgG.
Mary Ellen



Mary Ellen Conley, MD
Department of Immunology/ Mail Stop 351
St. Jude Children's Research Hospital
262 Danny Thomas Place
Memphis, TN 38105-3678
FAX  901-595-3977
TEL  901-595-2576



________________________________
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Richard Wasserman
Sent: Wednesday, April 28, 2010 1:41 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] IVIG or not?

I would treat. So far prophylaxis has been lucky but his next pneumonia could result in bronchiectasis.
Richard Wasserman

On Wed, Apr 28, 2010 at 1:37 PM, Kobrynski, Lisa <lkobryn at emory.edu<mailto:lkobryn at emory.edu>> wrote:
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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Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
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