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

[Richard Wasserman]

Joe,
I would use prophylactic antibiotics. I know that local nasal hygiene and
treatment of allergic/non-allergic rhinitis has been optimized.
Richard


On Wed, May 8, 2013 at 9:53 PM, John Ziegler <j.ziegler at unsw.edu.au> wrote:


> **

> I would just watch.

>

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

> *From:* Church, Joseph [mailto:JChurch at chla.usc.edu]

> *Sent:* Thursday, 9 May 2013 12:13 PM

> *To:* CIS-PIDD

> *Subject:* [cis-pidd] Sibs with low IgG, normal Pneumo Abs

>

>   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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-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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