[PAGID] IVIG or not?

[Berger, Melvin]

Hi lisa-  Could the "pneumonias" really be atelectasis secondary to bronchospasm/hypersecretion and not infiltrate per se ?  Did he have elevated WBC and/or ESR or CRP with the "pnemonias".  
 
Melvin Berger, M.D., Ph.D.
Professor of Pediatrics and Pathology
Case Western Reserve University
phone 216 844 3237
 
Director, Jeffrey Modell Center for Primary Immune Deficiencies
Division of Allergy-Immunology
Rainbow, Babies and Children's Hospital
University Hospitals of Cleveland
RB&C Rm 504, MS 6008B
11100 Euclid Ave.
Cleveland, OH 44106

________________________________

From: pagid-bounces at list.clinimmsoc.org on behalf of Conley, Mary Ellen
Sent: Wed 4/28/2010 5:40 PM
To: 'pagid at list.clinimmsoc.org'
Subject: Re: [PAGID] IVIG or not?


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> 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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DallasAllergyImmunology
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