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I have a patient with CVID who is on monthly intravenous gammaglobulin. She is quite stable in terms of bacterial infections and recently received two doses of Pfizer COVID-19 vaccine. Four weeks after the last vaccination dose and before her scheduled IVIG infusion, I measured her antibodies to the spike protein. The antibody test performed at Quest revealed undetectable antibody levels. What advice can I give her going forward other than mask wearing and social distancing. Would she better respond to a non-messenger RNA vaccine–please advise.


By definition, individuals with common variable immunodeficiency fail to mount effective antibody responses. There are no anti-COVID-19 antibodies in the current intravenous gammaglobulin preparations. Individuals with common variable immunodeficiency tend to do fairly well with COVID-19 infections. The vaccine in this setting is mainly stimulating anti-COVID-19 T cell immunity. She should follow the standard guidelines that any COVID-19 vaccinated person is encouraged to follow.

I hope this information is helpful for you and your patient.

Eric Macy, MD, MS, FAAAAI


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