Q:

1/7/2013
I am following a 62 year old female with a diagnosis of CVID. She was diagnosed some 15 years ago. Classic history and laboratory findings. Was started on IVIG initially, then switched to SCIG. Did well with IgG's on therapy in the normal range. Had a CVA some five years into therapy. In rehab center, pt was off SCIG for some eight weeks...repeat serum immunoglobulins were wnl! Had a normal response to pneumovax as well. Watched pt off SCIG for 18 mos. Repeat QIGs again dropped into CVID range and random pneumococcla titers all mostly dropped into the non-protective range. SCIG was resumed and pt has done well. After another recent SCIG lapse, decided to reevaluate pt. Seven weeks off SCIG, IgG is 717, IgM is 45, and IgA is 194. Had an excellent response to Hib and tetanus immunization, but poor response following reimmunization with Pneumovax (4/14).

I can't explain why the immunoglobulins are waxing and waning so erratically...I don't think that's typical for CVID. Need to decide though whether to resume SCIG. Patient wants to resume and my inclination is to restart, but wondering if you could offer a second opinion. Thanks.

A:

Thank you for your inquiry.

I am asking Dr. Charlotte Cunningham-Rundles, an international expert in common variable immunodeficiency disease, to respond to your inquiry. As soon as we hear from Dr. Cunningham-Rundles, we will forward her response to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Charlotte Cunningham-Rundles regarding your Ask the Expert inquiry. Thank you again for your inquiry, and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Charlotte Cunningham-Rundles:
This levels and fluctuation are puzzling; generally we see them going down, not up. So I don't have a good explanation for this either unless there was some use of steroids or other medications (medications used in neurology/psychiatry can do this) in the past, and not now. However, at this time, the IgG is fine and the antibodies (only the pneumococcal response is lackluster) are not very depressed either, so one might just wait and see what the levels are in more time.

Even with the original levels, not sure I would use the term CVID either; she is more IgG deficient (279.03)

Charlotte Cunningham-Rundles

AAAAI - American Academy of Allergy Asthma & Immunology