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

Thu Jan 22 14:19:45 EST 2015

Dear Soheil,

Nearly absent IgA and IgM increases the risk of upper respiratory tract
infections in your patient. 2 episodes per year is not that much and you
maintain the patient quite stable with decent trough IgG levels and minor
infections. I would be hesitant to increase SQ dosage. But any answer to
this precise question may be controversial.

Best regards,

Luis Ignacio Gonzalez-Granado
Immunodeficiencies Unit
Pediatric Hematology & Oncology Unit.
Pediatrics
Hospital 12 octubre.
Madrid. Spain

2015-01-22 20:06 GMT+01:00 Keller, Michael <MKeller at childrensnational.org>:

>  Hi Soheil,
>
>  Increasing his hizentra dose sounds like a very good move as we often
> (albeit in pediatric patients) see much higher levels achieved with subQ.
>
>  You mention no bronchiectasis - has he had a recent chest CT or MRI to
> ensure that there is no developing interstitial disease?
>
>  Best regards,
> Mike
>
>   -------------------------
>
> Michael D. Keller MD
>
> Assistant Professor, Division of Allergy / Immunology
>
> Center for Cancer and Immunology Research
>
> Children's National Health System
>
> 111 Michigan Ave NW, Room 1W-314B
>
> Washington, DC 20010
>
> Clinic: 202.476.3016
>
> Office: 202.476.5843
>
> Fax: 202.476.2280
>
> www.childrensnational.org
>
>
>     ------------------------------
> *From:* Soheil Chegini [schegini at yahoo.com]
> *Sent:* Thursday, January 22, 2015 2:00 PM
> *To:* CIS-PIDD
> *Subject:* [cis-pidd] Sub-protective pneumococcal titers in a CVID
> patient on therapeutic doses of IgSQ and recurrent bronchitis
>
>   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                   0.9
> Type 3                   0.9
> Type 4                   <0.3
> Type 5                   1.4
> Type 8                   1.0
> Type 9                   0.7
> Type 12                 0.4
> Type 14                 3.3
> Type 19                 1.4
> Type 23                 0.9
> Type 26                 1.1
> Type 51                 1.3
> Type 56                 1.2
> Type 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
>
>  Soheil Chegini, 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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