[CIS PIDD] [cis-pidd] Sub-protective pneumococcal titers in a CVID patient on therapeutic doses of IgSQ and recurrent bronchitis

[Soheil Chegini]

Dear all,

I am wondering what others would suggest to reduce the frequency of bronchitis in a 54 y.o. man with CVID who is on Hizentra 10 g SQ weekly and has an excellent IgG level (814 in 6/14 and 916 1/15). He has responded well to oral antibiotics (Ceftin and Augmentin x 10 each) for 2 episodes of bronchitis that he has had this fall with resolution of his symptoms. He is also treated for asthma with Symbicort 160/4.5 and his spirometry is stable at his baseline with some irreversible airflow obstruction. No bronchiectasis.
Here are his 14-serotype pneumococcal titers:Type 1                   0.9Type 3                   0.9Type 4                   <0.3Type 5                   1.4Type 8                   1.0Type 9                   0.7Type 12                 0.4Type 14                 3.3Type 19                 1.4Type 23                 0.9Type 26                 1.1Type 51                 1.3Type 56                 1.2Type 68                 0.7  These titers suggest adequate protection only against 4 of the 14 tested serotypes, but I am not inclined to increase his dose of Hizentra given his excellent total IgG. He does not produce any Ig (IgA,7 and IgM 11), and his pre-Treatment IgG was 151. He is tolerating the infusions well and I have no other excuse to change the Ig preparation.
I would very much appreciate your help and advice. Thank you very much in advance.
Best regards,sc
SoheilChegini, M.D.
Exton Allergy & Asthma Associates
656 West Lincoln Hwy.
Exton, PA 19341
Phone: (610) 269-3066
Fax: (610) 269-8615



 
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