eMedicine Specialties > Allergy and Immunology > Immunodeficiencies

Immunoglobulin G Deficiency: Differential Diagnoses & Workup

Author: Robert Y Lin, MD, Professor, Department of Medicine, Medical Advisor, Department of Case Management/Utilization Review, New York Medical College; Chief, Allergy and Immunology Section, St Vincent's Catholic Medical Centers, St Vincent's of Manhattan
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Jul 9, 2009

Differential Diagnoses

Other Problems to Be Considered

The wide range of normal levels of IgG subclasses in children may make the differential diagnosis of IgG deficiency difficult until the patient is as old as 4-5 years, at which time the IgG concentration approaches adult levels. Specific antibody responses to required immunizations may be more revealing and of greater significance than total IgG or IgG subclass measurements.4,5,6

Workup

Laboratory Studies

  • Values or all immunoglobulin (Ig) levels for pediatric patients must be compared with normal laboratory values for age.
  • Many experts doubt the utility of IgG subclass measurements.17,15 Measuring functional or specific antibodies is important for determining the clinical relevance of a particular IgG subclass deficiency, and these tests can be obtained by several commercial reference laboratories. Patients may have normal total serum immunoglobulin and IgG subclass levels and still fail to make certain antibodies to bacterial or viral pathogens. The specific antibodies include tetanus/diphtheria antibodies (IgG1) and pneumococcal and meningococcal polysaccharides (IgG2 and IgG3).
  • Several methods are available for measuring IgG subclasses, the most common of which is enzyme-linked immunosorbent assay (ELISA) with either monoclonal or polyclonal antibodies. Radial immunodiffusion is rarely used in modern laboratories. Results vary according to the exact method and antibody combinations used. Therefore, results should be compared to age-specific norms generated in the same laboratory.

Imaging Studies

  • Radiographic studies may help monitor pulmonary infections, document sinusitis, and identify the development of chronic pulmonary changes such as bronchiectasis.

Other Tests

  • Pulmonary function studies also may be useful.
  • Cultures obtained by bronchoscopy or sinus endoscopy may be helpful in cases of chronic bronchitis, cough, or both.

More on Immunoglobulin G Deficiency

Overview: Immunoglobulin G Deficiency
Differential Diagnoses & Workup: Immunoglobulin G Deficiency
Treatment & Medication: Immunoglobulin G Deficiency
Follow-up: Immunoglobulin G Deficiency
Multimedia: Immunoglobulin G Deficiency
References
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Further Reading

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Keywords

immune deficiency, immune globulin deficiency, IgG deficiency, IgG subclass deficiency, insufficient antibody production, gammaglobulin deficiency, hypogammaglobulinemia, immune deficiency, immunity, immunology, immune function, immunologic system interaction, autoimmune disorders, T-cell disease, B-cell dysfunction, complement deficiency, immunological disturbances, white blood cell diseases, WBC diseases, immunotherapy, intravenous immune globulin treatment, IVIG treatment, IV immunoglobulin treatment, common variable immunodeficiency, CVI, CVID, ataxia-telangiectasia, Sjogren syndrome, Sjogren's syndrome, X-linked agammaglobulinemia, X-LA, XLA, congenital agammaglobulinemia, transient hypogammaglobulinemia of infancy, Bruton’s, sinusitis, chronic sinusitis, recurrent sinusitis, tympanic membrane, effusion of middle ear, middle ear effusion

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Contributor Information and Disclosures

Author

Robert Y Lin, MD, Professor, Department of Medicine, Medical Advisor, Department of Case Management/Utilization Review, New York Medical College; Chief, Allergy and Immunology Section, St Vincent's Catholic Medical Centers, St Vincent's of Manhattan
Robert Y Lin, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American Federation for Medical Research
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Melvin Berger, MD, PhD, Adjunct Professor of Pediatrics and Pathology, Case Western Reserve University; Senior Medical Director, Clinical Research and Development, CSL Behring, LLC
Melvin Berger, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Clinical Investigation, and Clinical Immunology Society
Disclosure: CSL Behring Salary Employment

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael R Simon, MD, MA, Clinical Professor Emeritus, Departments of Internal Medicine and Pediatrics, Wayne State University School of Medicine; Adjunct Staff, Division of Allergy and Immunology, Department of Internal Medicine, William Beaumont Hospital
Michael R Simon, MD, MA is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, American Federation for Medical Research, Michigan Allergy and Asthma Society, Michigan State Medical Society, Royal College of Physicians and Surgeons of Canada, and Society for Experimental Biology and Medicine
Disclosure: Secretory IgA, Inc. Ownership interest Board membership

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michael A Kaliner, MD, Clinical Professor of Medicine, George Washington University School of Medicine; Chief, Section of Allergy and Immunology, Washington Hospital Center; Medical Director, Institute for Asthma and Allergy
Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, and Association of American Physicians
Disclosure: Abbott Consulting fee Consulting; Alcon Consulting fee Consulting; Glaxo Consulting fee Consulting; Greer Consulting fee Consulting; Sanofi Consulting fee Consulting; Schering Consulting fee Consulting; Teva  Consulting; Meda Honoraria Speaking and teaching

 
 
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