[CIS-PAGID] Asymptomatic hypogammaglobulinemia

[mriedl at mednet.ucla.edu]

As Andy said, this is a relatively common presentation for us at UCLA. I sometimes monitor without treatment if that's  the patient's preference and no significant history of infection. I would only add that I've been "fooled" in couple of hypogam/CVID patients over the last few years who had no discernible history of pulmonary infection but with their first respiratory symptoms clearly had developed bronchiectasis. So I would be sure to document a normal DLCO and have a low threshold for chest CT if electing to observe. 

Marc 
-----Original Message-----
From: "Ballas, Zuhair" <zuhair-ballas at uiowa.edu>
Sender: "pagid-bounces at list.clinimmsoc.org"
	<pagid-bounces at list.clinimmsoc.org>
Date: Fri, 31 Dec 2010 08:53:36 
To: pagid at list.clinimmsoc.org<pagid at list.clinimmsoc.org>
Reply-To: "pagid at list.clinimmsoc.org" <pagid at list.clinimmsoc.org>
Subject: Re: [CIS-PAGID] Asymptomatic hypogammaglobulinemia

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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