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Phenotypic Parameters Predict Time to Normalization in Infants with Hypogammaglobulinemia

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Abstract

Purpose

Infants with recurrent infection may be found to have hypogammaglobulinemia without impaired specific antibody responses. Many will be diagnosed with transient hypogammaglobulinemia of infancy.

Methods

This study used a parametric survival analysis of 100 infants with hypogammaglobulinemia to predict time to normalization.

Results

Aggregate initial immunoglobulins (IgG + IgA + IgM), as a percentage of age-adjusted normal, predicted time to resolution: median time to resolution for the infants in the lowest quartile of aggregate levels (≤81 % of age-adjusted lower limits) was greater than 5 years, with 34 % resolving in 3 years. For infants in the highest quartile (≥130 % of age-adjusted lower limits), the median was 9.9 months, with 77 % resolving in 3 years (P = 0.008). Initial IgG level, as a percentage of age-adjusted normal, also predicted resolution: the median time in the lowest quartile (≤78 % of age-adjusted lower limits) was greater than 5 years, with 36 % resolving in 3 years. In the highest quartile (≥128 %), the median time was 14.5 months, with 70 % resolving in 3 years (P = 0.010). Male sex was associated with more rapid resolution. The median time in males was 13 months, with 73 % resolution in 3 years. The median time in females was greater than 5 years, with 32 % resolution in 3 years.

Conclusions

These results suggest that if a term infant presents with hypogammaglobulinemia, protective specific antibody titers, and an absence of other known immune deficiency, initial immunoglobulin levels and sex may predict time to normalization.

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Acknowledgments

The authors thank Christopher C. Chang, MD, PhD, for his ideas regarding established normal values of immunoglobulins.

Conflicts of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Thomas Jefferson University, Philadelphia, PA, USA

    Robert C. Van Winkle & Stephen J. McGeady

  2. Sycamore Consulting, LLC, Philadelphia, PA, USA

    Walter W. Hauck

  3. Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, 19899, USA

    Stephen J. McGeady

Authors
  1. Robert C. Van Winkle
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  2. Walter W. Hauck
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  3. Stephen J. McGeady
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Corresponding author

Correspondence to Stephen J. McGeady.

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Van Winkle, R.C., Hauck, W.W. & McGeady, S.J. Phenotypic Parameters Predict Time to Normalization in Infants with Hypogammaglobulinemia. J Clin Immunol 33, 1336–1340 (2013). https://doi.org/10.1007/s10875-013-9937-7

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  • DOI: https://doi.org/10.1007/s10875-013-9937-7

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