[CIS-PAGID] Asymptomatic hypogammaglobulinemia

[Church, Joseph]

I would like to thank everyone for their insight and input.  It will very helpful when I discuss treatment options with the patient and his wife on Monday.

Happy New Year to you all!

Joe Church

-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Charlotte cunningham-rundles
Sent: Thursday, December 30, 2010 3:58 PM
To: PAGID
Subject: Re: [CIS-PAGID] Asymptomatic hypogammaglobulinemia

I agree with Marguerite, that those with no Ig to mention and no antibody
can have very severe infections as an outcome -- have seen a few that
someone sat on for a while. So, of course I'd treat them myself too.



Lengkeek, Marguerite S. LCDR


> Have you checked for any secondary loss of protein/immunoglobulin?  Does he

> have any GI symptoms that might cause a protein losing enteropathy?  Have

> you considered ordering stool alpha 1 anti-trypsin and urine protein or

> UPEP?  

> 

> The other cases with the almost absent Ig run the risk of their first

> infections being severe ones.  I follow 2 CVID patients that were

> misdiagnosed until their 60s. One was picked up after H. flu meningitis with

> gross pus from his spinal tap and a week in the ICU comatose on a vent.  The

> other was picked up after S. pneumoniae sepsis.  They did have infections

> (sinusitis and PNA) previously, so they may be different.

> 

> Sincerely,

> 

> Marguerite S. Lengkeek, MD

> LCDR, MC, USN

> Division Head, Allergy and Immunology

> Naval Medical Center San Diego

> Naval Training Center

> 2051 Cushing Rd.

> San Diego, CA  92106

> (619) 524-1519 

> Marguerite.lengkeek at med.navy.mil

> 

> 

> -----Original Message-----

> From: pagid-bounces at list.clinimmsoc.org

> [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Charlotte

> cunningham-rundles

> Sent: Thursday, December 30, 2010 11:55 AM

> To: PAGID

> Subject: Re: [CIS-PAGID] Asymptomatic hypogammaglobulinemia

> 

> 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

> 

> ---------------------------------------------------------------------CONFIDE

> NTIALITY NOTICE: This e-mail message, including any attachments,

> is for the sole use of the intended recipient(s) and may contain

> confidential

> or legally privileged information. Any unauthorized review, use,

> disclosure

> or distribution is prohibited. If you are not the intended

> recipient, please

> contact the sender by reply e-mail and destroy all copies of this

> original message.

> ---------------------------------------------------------------------

> 

> 

> 

> 

> 





---------------------------------------------------------------------
CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, 
is for the sole use of the intended recipient(s) and may contain confidential
or legally privileged information. Any unauthorized review, use, disclosure
or distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply e-mail and destroy all copies of this original message.  

---------------------------------------------------------------------