[CIS PIDD] [cis-pidd] Milder CVID phenotype with pregnancy

Wed Jun 4 16:37:31 EDT 2014

Zach,

Premees are routinely born with very low IgG (maternal transfer does not start till around 25-26 weeks’ gestation) and several studies have shown no benefit to administering IVIG vs placebo to these infants.

Tom

Thomas G. Boyce, MD, MPH
Pediatric Infectious Diseases and Immunology
Mayo Clinic
Rochester, MN 55905
phone: 507-255-8464
fax: 507-255-7767

From: Zachary D. Jacobs, MD [mailto:zjacobs.md at gmail.com]
Sent: Wednesday, June 04, 2014 3:02 PM
To: CIS-PIDD
Subject: [cis-pidd] Milder CVID phenotype with pregnancy

Dear Colleagues,

I am following a 34 year old woman with a milder CVID phenotype characterized by an IgG in the mid 400s, IgA in the 30s, normal IgM and a moderate specific antibody deficiency with pre/post Pneumovax testing.  Her pattern of infections has not been that bad at all and since her diagnosis about 18 months ago we have just been watching her and she has doing really well just with expectant/supportive therapy - no supplemental immunoglobulin.

She is now 21 weeks pregnant and still doing well. However, I was wondering if it might be beneficial to give her 1-2 doses of IVIG in the third trimester leading up to birth to optimize passive transfer of IgG to the baby, thinking that it might be better off for the infant to have a more "normal"  IgG at birth so the physiologic nadir won't hit rock bottom with him/her.

Any thoughts or experience with this scenario would be appreciated.

Thanks as always.

Zach

--
Zachary D. Jacobs, M.D.

The Center for Allergy & Immunology

Kansas City Physician Partners
Medical Plaza II
4330 Wornall, Suite 40
Kansas City, MO 64111

Ph: 816.531.0930
Fax: 816.753.2671

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