IVIG indications: hypogammaglobulinemia and peripheral neuropathy
Question:
4/2/2018
55 year-old female referred to me for hypogammaglobulinemia (IgG 461, IgA 28, IgM 29) which was found during a work up of peripheral neuropathy. SPEP/UPEP demonstrated no monoclonal proteins. CT SCAN ruled out thymoma. Vaccine titers for mumps, rubella, tetanus, diphtheria were protective and pneumococcal (83% protective response). Negative for autoimmune antibodies. No frequent or severe infections. Repeat immunoglobulins last week (IgG 470, IgA 27, IgM 24). Neurology work up continues. Is there anything else that should be evaluated? Is IVIG indicated in this patient with low immunoglobulins but no history of severe infections and excellent vaccine titer response?
Answer:
From Perez EE, et al. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol 2017; 139: S1-46, IVIG for this patient currently is not indicated.
IVIG is beneficial for the following peripheral neuropathies: Guillain Barre, chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). If the neurological evaluation could narrow down the specific peripheral neuropathy to this group, then the patient could potentially benefit from IVIG.
Regarding the hypogammaglobulinemia diagnosis, in the absence of recurrent infections or impaired specific antibody production, IVIG is not indicated.
Patricia McNally, MD, FAAAAI