[PAGID] IVIG or not?

[Kobrynski, Lisa]

Thanks to everyone for their input.
I think I knew what the majority opinion would be, but it is always helpful to benefit from the collective wisdom.
FYI:  His IgA and IgM are dropping along with the IgG so levels of all 3 are below the normal age appropriate reference range.
LK

Lisa Kobrynski, MD, MPH
Associate Professor of Pediatrics
Section, Allergy/Immunology

________________________________
From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] On Behalf Of Berger, Melvin [Melvin.Berger at UHhospitals.org]
Sent: Wednesday, May 05, 2010 7:49 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] IVIG or not?

How do we know he does not have a mutation in FcRn ?  That would be expected to lead to low total IgG but B cells and specific antibodies may be unaffected. Supplementing with IVIG or SCIG may raise the total IgG level when FcRn becomes saturated. If FcRn was abnormal, IgA and igM might be normal- what are his levels of those ?

Melvin Berger, M.D., Ph.D.
Adjunct Professor of Pediatrics and Pathology
Case Western Reserve University

________________________________
From: pagid-bounces at list.clinimmsoc.org on behalf of Routes, John
Sent: Tue 5/4/2010 12:16 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] IVIG or not?



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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