title: Efficacy of intravenous gammaglobulin for immunoglobulin G subclass and/or antibody deficiency in adults.
abstract: BACKGROUND
  The clinical significance and efficacy of treating patients who have immunoglobulin (Ig) G subclass deficiency and/or antibody deficiency with Ig-replacement therapy has been debated. There are no clear guidelines to recommend intravenous gammaglobulin (IgIV) in these patients as there are few published studies documenting its efficacy.
  
  
  METHODS
  We studied in an open-label protocol 10 adult patients with recurrent respiratory infections and IgG subclass and/or antibody deficiency. All patients received monthly IgIV for 12 months and then were observed for 3 months without IgIV infusions. We studied quality of life, incidence of infections, need for antibiotics, frequency of hospitalizations due to infections, IgG subclass and antibody (tetanus and pneumococcal) levels. Innate immunity was evaluated by studying the status of Toll-like receptors and polymorphisms, mannan-binding lectin levels and genotypes. Correction of the immune defects during IgIV therapy was evaluated.
  
  
  RESULTS
  Monthly IgIV significantly improved quality of life, decreased the number of infections and the need for antibiotics, and improved IgG subclass and antibody serum levels. No consistent finding of innate immunity could be detected.
  
  
  CONCLUSIONS
  IgIV could be beneficial in patients with IgG subclass or antibody deficiency.
authors.affiliation: Center for Rheumatic Disease and Center for Allergy and Immunology, Kansas City, Mo. 64111, USA. niabdou@centerforrheumatic.com
authors.forename: Nabih I
authors.initials: NI
authors.lastname: Abdou
authors.forename: Cindy A
authors.initials: CA
authors.lastname: Greenwell
authors.forename: Reena
authors.initials: R
authors.lastname: Mehta
authors.forename: Madhu
authors.initials: M
authors.lastname: Narra
authors.forename: Jeffery D
authors.initials: JD
authors.lastname: Hester
authors.forename: John F
authors.initials: JF
authors.lastname: Halsey
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005838:Genotype; D006801:Humans; D017099:IgG Deficiency / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood*; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood / Q000235:genetics; D008875:Middle Aged; D011110:Polymorphism, Genetic; D011788:Quality of Life; D011795:Surveys and Questionnaires; D051193:Toll-Like Receptors / Q000235:genetics / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D037601:Mannose-Binding Lectin; D051193:Toll-Like Receptors