[CIS-PAGID] Asymptomatic hypogammaglobulinemia

[Berger, Melvin]

This sounds more like CVID with retention of a few protein antibody responses rather than an otherwise normal immune system with an inability to respond to a few carbohydrate antiens. It would be very interesting to know what happens over time- does the switched B memory population continue to gradually decrease. What happens to their T-cell help over time ?  I always felt clinically that there was a group of patients who had been quite well as teen agers and young adults, then started to develop increased frequency/severity of infections in their 40s and 50s. I thought of them as having "premature senescence" of their immune system. I used the criterion of chest infections/obstructive lung disease as the indication for IgG supplementation. 
 
Melvin Berger, M.D., Ph.D.
Adjunct Professor of Pediatrics and Pathology
Case Western Reserve University
Cleveland, OH 44106

________________________________

From: pagid-bounces at list.clinimmsoc.org on behalf of Kirkpatrick, Charles
Sent: Thu 12/30/2010 10:48 AM
To: 'pagid at list.clinimmsoc.org'
Subject: Re: [CIS-PAGID] Asymptomatic hypogammaglobulinemia



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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