Q:

12/16/2013
I'm currently evaluating a 47 year old female with a history of recurrent sinusitis. Initial immune screen revealed an IgG of 429, IgM<7, IgA of 45 and IgE<1.5. None of the baseline pneumococcal AB titers were in the protective range (all very low), but 11/14 in protective range post immunization. Baseline HIB titer missed, but post vaccination IgG titer was 90. Tetanus baseline titer was 2.2. Serum albumin wnl.

Patient has up to 10 episodes of sinusitis per year...no history of pneumomonia or other types of recurrent infections. So moderate degree of hypogammaglobulinemia, but good AB response to immunization. Would you consider immuneglobulin replacement therapy for this patient or prophylactic antibiotics? Thanks for your thoughts.

A:

Thank you for your inquiry.

There is no "right or wrong" response to your question. I believe you may get different opinions from different allergists-immunologists in this regard. My own personal opinion is that, unless your patient has documented evidence of chronic or destructive bacterial infection (e.g., chronic hyperplastic sinusitis, bronchiectasis, or documented bacterial pneumonias), I would not start immunoglobulin replacement treatment at this time. A trial of prophylactic antibiotics would be reasonable, but I personally would not administer prophylactic treatment unless there was evidence that the "sinus infections" were bacterial in nature.

Having said this, as mentioned, you may get differing responses, especially regarding the institution of prophylactic antibiotics, from allergists-immunologists knowledgeable in this area.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology