Improved IgG3 Levels and Reduced Infection Rate in CVID
Improved IgG3 Levels and Reduced Infection Rate in CVID
Aim: To report the interesting case of a patient with common variable immune deficiency disease who demonstrated varied responses to intravenous (IV) and subcutaneous (SC) immunoglobulin (Ig) therapy with regard to both infection frequencies and IgG3 subclass determinations.
Patient & methods: As part of routine medical care, the author monitored total and IgG subclass levels, along with infection frequencies in a 35-year-old woman, with recurrent sinopulmonary infections diagnosed with common variable immune deficiency disease.
Results: During treatment with IVIg, the patient's annual rate of infections decreased, although she experienced severe headaches. After being switched to daily SCIg therapy, the headaches stopped, and her annual infection rate declined further. Her IgG3 levels, which were undetectable during IVIg therapy, increased substantially during SCIg treatment.
Conclusion: The reason for the observed correlation between IgG3 level restoration and a decline in infection rate after being switched to SCIg therapy is not entirely clear. At the minimum, it may suggest that IgG3 levels may be a simple and useful surrogate marker to monitor Ig replacement sufficiency in certain patients.
In patients with primary immunodeficiency disease (PIDD), immunoglobulin (Ig) replacement can be performed through intravenous (IV) or subcutaneous (SC) administration. Regardless of the route chosen, individualizing the Ig dose is critical to ensure adequate serum IgG concentrations and achieve a good clinical outcome as reflected by infection rate. Monitoring of IgG levels is necessary because of inherent variations in patient pharmacokinetics, as well as dosing route and frequency effects. In patients receiving IVIg therapy, levels of each IgG subclass generally correlate closely with the relative proportions of each subclass in the IVIg preparation. The distribution of Ig subclasses in SCIg is similar to that seen in normal human plasma and subclass levels achieved during SCIg therapy are typically consistent with a physiologic distribution.
Failure to achieve and/or maintain adequate IgG subclass levels throughout Ig replacement therapy may place some patients at risk of infection. The case of an immunodeficient woman with undetectable IgG3 levels during IVIg therapy who, following a switch from IVIg to SCIg, experienced both a substantial increase in IgG3 levels and a reduction in infections, even at a lower total monthly Ig dose, is described.
Abstract and Introduction
Abstract
Aim: To report the interesting case of a patient with common variable immune deficiency disease who demonstrated varied responses to intravenous (IV) and subcutaneous (SC) immunoglobulin (Ig) therapy with regard to both infection frequencies and IgG3 subclass determinations.
Patient & methods: As part of routine medical care, the author monitored total and IgG subclass levels, along with infection frequencies in a 35-year-old woman, with recurrent sinopulmonary infections diagnosed with common variable immune deficiency disease.
Results: During treatment with IVIg, the patient's annual rate of infections decreased, although she experienced severe headaches. After being switched to daily SCIg therapy, the headaches stopped, and her annual infection rate declined further. Her IgG3 levels, which were undetectable during IVIg therapy, increased substantially during SCIg treatment.
Conclusion: The reason for the observed correlation between IgG3 level restoration and a decline in infection rate after being switched to SCIg therapy is not entirely clear. At the minimum, it may suggest that IgG3 levels may be a simple and useful surrogate marker to monitor Ig replacement sufficiency in certain patients.
Introduction
In patients with primary immunodeficiency disease (PIDD), immunoglobulin (Ig) replacement can be performed through intravenous (IV) or subcutaneous (SC) administration. Regardless of the route chosen, individualizing the Ig dose is critical to ensure adequate serum IgG concentrations and achieve a good clinical outcome as reflected by infection rate. Monitoring of IgG levels is necessary because of inherent variations in patient pharmacokinetics, as well as dosing route and frequency effects. In patients receiving IVIg therapy, levels of each IgG subclass generally correlate closely with the relative proportions of each subclass in the IVIg preparation. The distribution of Ig subclasses in SCIg is similar to that seen in normal human plasma and subclass levels achieved during SCIg therapy are typically consistent with a physiologic distribution.
Failure to achieve and/or maintain adequate IgG subclass levels throughout Ig replacement therapy may place some patients at risk of infection. The case of an immunodeficient woman with undetectable IgG3 levels during IVIg therapy who, following a switch from IVIg to SCIg, experienced both a substantial increase in IgG3 levels and a reduction in infections, even at a lower total monthly Ig dose, is described.
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