Survey of infection in patients receiving antibody replacement treatment for immune deficiency

Abstract

Background: Primary antibody deficiency disorders are a heterogeneous group of disorders, which are treated by regular infusions of immunoglobulin. Despite replacement treatment, patients remain susceptible to infection. Effective management of infections is necessary to prevent the complications of chronic infection.

Infection outcomes in patients with common variable immunodeficiency disorders: Relationship to immunoglobulin therapy over 22 years

“…Analysis of bacterial infections showed that the majority of infections (86%) were respiratory, similar to reports of other cohorts of patients with CVIDs. 9,25 Encouragingly, only 1.7% of the total bacterial infections were severe, in line with the local policy of adjusting the therapeutic immunoglobulin dose to minimize breakthrough infections. The low number of serious infections supports previous studies of partial efficacy showing reduced rates of pneumonia 4,8,10 and serious infections 5,9,13 after commencement of replacement therapy.…”

“…Locally the mean trough IgG has significantly increased over the past 3 decades, highlighting the need to provide updated guidance. 9,[16][17][18][19][20][21][23][24][25] Although the mean replacement dose of immunoglobulin increased over the 3 decades, the mean numbers of infections per patient-year appears to have reached a plateau, hence the need to break the data into infection-free periods for each patient.…”

“…9,13,[16][17][18][19][20] In contrast, some report no change in infection frequency [21][22][23][24] and no correlation with serum IgG levels. 25 However, patient numbers are low (a maximum of 27 patients with CVIDs), and reports often include several types of antibody deficiency and are limited by short follow-up periods 20 and little infection detail, comparing only short periods before and after immunoglobulin replacement therapy. 11,12 Most published guidelines recommend trough IgG levels of around 6 to 8 g/L to be achieved with a dose of 400 mg/kg every 3 to 4 weeks [26][27][28][29] ; consensus is based largely on expert opinion and systematic reviews of such limited data.…”

Allogeneic stem cell transplantation: low immunoglobulin levels associated with decreased survival

“…Patients with serum IgG values below 4 g/l were defined as significantly deficient according to the existing guidelines for antibody-replacement therapy. 29,30 Measurement of IgG Levels Serum samples for measurement of IgG levels were collected 3, 6, 9 and 12 months following hemopoietic stem cell transplantation and then at yearly intervals until 5 years posttransplantation. Serum IgG was analyzed routinely by nephelometry at Karolinska University Laboratory, Department of Clinical Chemistry.…”

Administering intravenous immunoglobulin during infection is associated with infusion reactions in selected patients

“…Immune dysfunction in CVID may account for the very variable baseline CRP in this condition [11]. CRP is a marker of inflammation, and is only an indirect suggestion that infection is actually present.…”