[PAGID] IVIG or not?

[Routes, John]

I agree---I would start IVIG or SCIG
Jack Routes




> From: "Sorensen, Ricardo" <RSoren at lsuhsc.edu>

> Reply-To: "pagid at list.clinimmsoc.org" <pagid at list.clinimmsoc.org>

> Date: Mon, 3 May 2010 16:32:48 -0500

> To: "pagid at list.clinimmsoc.org" <pagid at list.clinimmsoc.org>

> Subject: Re: [PAGID] IVIG or not?

>

> 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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