Frequent infections may be a sign of immunodeficiency

MILWAUKEE—Children who get frequent infections, such as ear infections, sinusitis or pneumonia, may have a more severe condition called immunodeficiency, according to the American Academy of Allergy, Asthma & Immunology (AAAAI).

Patients who have immunodeficiency have infections that usually do not go away without using antibiotics and often recur within one or two weeks after antibiotic treatment is completed. These patients frequently need many courses of antibiotics each year to stay healthy. There are several forms of immunodeficiency and while some are very severe and life-threatening, many are milder but still important enough to cause recurrent or severe infections.

“People with immunodeficiency get the same kinds of infections that other people get—ear infections, sinusitis and pneumonia,” said Jordan Orange, MD, PhD, FAAAAI, Chair of the AAAAI's Primary Immunodeficiency Diseases Committee. “The difference is that their infections occur more frequently, and are often more severe, and have a greater risk of complications.”

Allergist/immunologists often use the frequency of the use of antibiotics to mark the frequency of significant infections. General guidelines for determining if a patient may be experiencing too many infections are:

• The need for more than four courses of antibiotic treatment per year in children or more than two times per year in adults.
• The occurrence of more than four new ear infections in one year after four years of age.
• The development of pneumonia twice over any time.
• The occurrence of more than three episodes of bacterial sinusitis in one year or the occurrence of chronic sinusitis.
• The need for preventive antibiotics to decrease the number of infections.
• Any unusually severe infection or infections caused by bacteria that do not usually cause problems in most people at the patient's age.

When to see an allergy/asthma specialist

If your child has any of these conditions, consult with an allergist/immunologist for more information on recurrent infections, immunodeficiency, proper diagnosis and treatments.

The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:

• Have chronic or recurrent infectious rhinosinusitis.
• Have any of the following warning signs:
• Eight or more new infections within one year.
• Two or more serious sinus infections within one year.
• Two or more months on antibiotic with little or no effect.
• Two or more pneumonias within 1 year.
• Failure of an infant to gain weight or grow normally.
• Recurrent deep skin or organ abscesses.
• Persistent thrush in mouth or elsewhere on skin after age 1 year.
• Need for intravenous antibiotics to clear infections.
• Two or more deep seated infections.
• A family history of immune deficiency.

The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Allergy/immunology specialists are pediatric or internal medicine physicians who have elected an additional two years of training to become specialized in the treatment of asthma, allergy and immunologic disease. Established in 1943, the AAAAI has more than 6,000 members in the United States , Canada and 60 other countries. The AAAAI serves as an advocate to the public by providing educational information through its Web site at www.aaaai.org .

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