Thank you for your inquiry.
We have dealt with this on a number of occasions on our website. There is indeed no consensus, and different consultants have offered different views. My own policy has been to treat only if the patient is symptomatic, shows an inadequate response to immunization to pneumococcus, and/or has some evidence of chronic bacterial infection such as bronchiectasis or chronic hyperplastic sinusitis. However, as mentioned, there are differences of opinion in this regard.
I believe going through some of our other entries would be helpful to you. These are:
1. 12/23/2013 - Indications for the administration of immunoglobulin replacement therapy
2. 09/16/2013 - Immunoglobulin replacement therapy in a patient with relatively normal immunoglobulins
3. 07/08/2013 - Indications for immunoglobulin replacement therapy in a patient with normal immunoglobulin levels
4. 06/11/2013 - Indications for immunoglobulin replacement therapy versus antibiotic prophylaxis
5. 04/29/2013 - Criteria for the administration of immunoglobulin replacement therapy
6. 03/25/2013 - Nuances of immunoglobulin replacement therapy
7. 02/04/2013 - When to administer immunoglobulin replacement therapy
These are just some of our latest entries. There are others that have been posted in earlier years, and you could reach them by clicking here and searching "immunoglobulin replacement". A review of these will give you "all sides of the issue" and help clarify the rationale suggested by various consultants.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.