[CIS PIDD] [cis-pidd] Sibs with low IgG, normal Pneumo Abs

[Church, Joseph]

Colleagues:

I am following a sister (4yo) and her brother (2½yo) with recurrent URIs and otitis media from <1year of age.  They have not experienced pneumonias or other invasive infections.  Their growth and development have been normal.  Their physical examinations have been normal except for evidence of chronic ear/sinus disease.

Labs on both show normal CBCs etc.

Sister (4+ yo):
                IgG repeatedly (from 1yo) below normal range; currently 484 mg/dl
                IgA 35, IgM 107
                IgE (in past) 17 IU/ml
                Tetanus and Hib antibodies protective
                Mannose binding lectin normal
                Pneumococcal antibodies after earlier Prevnar and then Pneumovax, + for 18 of 23 serotypes tested, stable for > 1 year.

Brother (2 ½ yo):
                IgG repeatedly below normal range; currently 367 mg/dL
                IgA 49, IgM 55
                IgE 17 IU/mL
                Tetanus antibody protective; Hib antibody initially protective, now non-protective.
Pneumococcal antibodies after earlier Prevnar and then Pneumovax at 2yo, + 19 of 23 serotypes tested at 1 month, now +16 of 23 at 4 months post pneumovax.

This past winter was difficult for both kids.

WHAT WOULD YOU SUGGEST:
                          TREAT AT THIS TIME (if I can get insurance to cover)?
                          CHECK ANTIBODIES IN 4 MONTHS?  IF DECREASED TREAT?
                          WHAT IF THEY MAINTAIN THEIR CURRENT IgG LEVELS AND PNEUMOCOCCAL ANTIBODIES, BUT CONTINUE TO BE SICK?

I would appreciate any thoughts or comments.  Thanks.

Joe Church
Children's Hospital Los Angeles





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