Progression of selective IgA deficiency to common variable immunodeficiency.
Selective IgA deficiency (IgAD) is the most common primary immunodeficiency in Caucasians. Although it is often asymptomatic, selected patients show an increased frequency of infections, allergies and autoimmune manifestations. Common variable immunodeficiency (CVID) is a primary antibody deficiency disease that shares many clinical features with IgAD. A common genetic basis for IgAD and CVID has been suggested based on their occurrence in members of the same family and the similarity of the underlying B cell defects. Progression from IgAD to CVID has also been reported in several cases. Here we present 4 patients with IgAD and autoimmune features who subsequently developed CVID. All symptomatic IgAD patients, especially those with associated IgG subclass deficiency or autoimmune features, should be monitored for evolution to CVID. Early diagnosis of this conversion and institution of immunoglobulin therapy is effective in preventing severe bacterial infections and pulmonary insufficiency.
Department of Allergy and Clinical Immunology, Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran. aghamohammadi@sina.tums.ac.ir
Asghar
A
Aghamohammadi
Javad
J
Mohammadi
Nima
N
Parvaneh
Nima
N
Rezaei
Mostafa
M
Moin
Teresa
T
Espanol
Lennart
L
Hammarstrom
D000328:Adult; D017074:Common Variable Immunodeficiency / Q000097:blood / Q000175:diagnosis* / Q000235:genetics; D005260:Female; D005838:Genotype; D006680:HLA Antigens / Q000235:genetics*; D006801:Humans; D017098:IgA Deficiency / Q000097:blood / Q000175:diagnosis* / Q000235:genetics; D007136:Immunoglobulins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D020641:Polymorphism, Single Nucleotide; D053303:Transmembrane Activator and CAML Interactor Protein / Q000235:genetics
D006680:HLA Antigens; D007136:Immunoglobulins; C108467:TNFRSF13B protein, human; D053303:Transmembrane Activator and CAML Interactor Protein