[PAGID] IVIG or not?

[Sorensen, Ricardo]

I would treat this clearly hypogammaglobulinemic patient with
infections, regardless of the pneumococcal antibody concentrations. The
latter may be transient, ineffective or not representative of many other
components of the antibody deficiency that this patient clearly has. I
have waited and not given IgG in similar patients and sooner or later
they will develop additional infections.

Ricardo Sorensen  

-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of John Ziegler
Sent: Thursday, April 29, 2010 1:57 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] IVIG or not?

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


________________________________________
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

________________________________
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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