COVID-19 and IgG replacement therapy
Question:
8/12/2020
A 47 year-old white female with a past medical history of recurrent infections years ago. Immune evaluation revealed normal QIA with inadequate response to pneumococcal titres. She was treated with IgRTx until December when she decided it was inconvenient and it was discontinued. She has done well without recurrent infections. She is employed as a teacher and is concerned she may become infected with COVID-19 and requested she resume IgRTx. Repeat immune work up revealed persistently normal QIA and only 3/23 pneumococcal titres protective. In addition to resuming IgRTx she requests a letter for short term and possibly long-term disability. In the absence of recurrent infections, I will not resume the IgRTx, however how likely is she to become infected with COVID-19 and have a poor outcome? Does she need to remain out of school for the duration of the pandemic?
Answer:
As far as I am aware there is no data to support the assertion that a patient with inadequate pneumococcal titers would be at increased risk for contracting COVID-19. I am not aware of any data that would support the off-label use of replacement IgG therapy to lower one's risk of contracting COVID-19. In addition, COVID-19 antibodies are not likely to be present in current immunoglobulin products, resumption of IgRTx would not be helpful in reducing her risk of infection and isn’t otherwise indicated based on the absence of recurrent infections.
I hope this is helpful.
Andrew Murphy, MD, FAAAAI