[PAGID] IVIG or not?

[John Ziegler]

I agree with Joe. If no protein loss then he has CVID and should start IVIG. I don't think normal B cell phenotyping helps with that decision. I assume his IgA and IgM are nromal in which case he should be checked for a form of HIGM as well as other causes of CVID.

John Ziegler


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From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph [JChurch at chla.usc.edu]
Sent: Thursday, April 29, 2010 4:56 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] IVIG or not?

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

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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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