[CIS-PAGID] Asymptomatic hypogammaglobulinemia

[Charlotte cunningham-rundles]

Hi Joe,


There are a lot of these around. We did a survey of our referrals for a 2
year block and came up with over 100 --- referred with just this question.
On paper, with pretty good antibodies, not CVID exactly. For insuracne, you
can use that term I guess, but as for treatment, as others noted, maybe Ig
is not currently needed.   If he came to me, I¹d do a bunch more antibodies
to firm up the current info, and follow yearly or more often if infections
became an issue.

PS: with regard to other exchanges:  Some CVID subjects, with virtually no
immune globulin, just do not have any infections. It is a real mystery, but
it is a real fact.  I have one like the one Andy mentioned, an engineer of
at least 60 now, with IgG of about 150, no IgA or M, with NO antibody and NO
infections. Sure, he is a CVID, but he refuses Ig, and has done for 15 or 20
years.  

PSS: have a wonderful New Year!


Charlotte

Church, Joseph


> 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

> Children¹s Hospital Los Angeles

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