[CIS-PAGID] Asymptomatic hypogammaglobulinemia

[Kirkpatrick, Charles]

Joe:

This setting comes up in adult patients a couple of times a year (at least in my clinic).  I check their memory B-cell panel; usually the isotype-switched population is low.  I have not treated them with IgG unless they have infections.  I know that others would treat such patients with IgG earlier.  Currently, the disorder looks more like selective antibody deficiency.

Chuck kirkpatrick

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph
Sent: Thursday, December 30, 2010 8:29 AM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Asymptomatic hypogammaglobulinemia

Colleagues:

I am seeing a 42yo man with no significant infection history.  A low globulin fraction on a chem. panel lead to his primary MD to obtain QUIGs:  IgG 309, IgA <7, IgM 30.  He has protective tetanus and Hib antibody, but responded to only 3 of 23 serotypes following Pneumovaxtm.

Review of past chem. panels suggest these finding have been present for 10 years.

Glaum and Levinson reported similar patients (Ann Allergy Asthma Immunol 2008;100:396-7), but I could not get a sense of what they did about their findings.

Should patients like this be placed on immunoglobulin replacement?

Joe Church
Children's Hospital Los Angeles

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