[CIS-PAGID] Asymptomatic hypogammaglobulinemia

[Ballas, Zuhair]

Joe

I also followed a patient who had non-detectable IgG, IgA or IgM in the
early 1980's. She refused replacement and had no infections until 2005
when she started coming down with pneumonias one of which landed her in
the ICU.

Zuhair

 

 

________________________________

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 1:55 PM
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, I'd
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
Children's Hospital Los Angeles
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