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.
Phil Lieberman, M.D.