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.^{[25, 21]}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).^{[26, 27]} Recurrent herpes simplx-2 lymphocytic meningitis in a 61-year-old woman may have been due to IgG subclass 2 deficiency.^[28]

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.

Treatment & Management

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Media Gallery

Immunoglobulin G deficiency. Schematic representation of an immunoglobulin G molecule. CH indicates constant region of heavy chain; CL, constant region of light chain; VH, variable region of heavy chain; and VL, variable region of light chain.
Immunoglobulin G deficiency. Human immunoglobulin G subclasses.
Immunoglobulin G deficiency. Changes in serum immunoglobulin G concentrations during infancy and childhood.
Immunoglobulin G deficiency. Schematic representation of the molecular interaction of CD40 on B cells, with CD40L on T cells involved in the switch from immunoglobulin M to immunoglobulin G.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Y Lin, MD Professor, Department of Medicine, New York Medical College; Chief, Allergy and Immunology, and Director of Utilization Review, Department Medicine, New York Downtown Hospital

Robert Y Lin, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, New York Allergy & Asthma Society

Disclosure: Nothing to disclose.

Janet Vafaie, MD Private Practice

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael R Simon, MD, MA Clinical Professor Emeritus, Departments of Internal Medicine and Pediatrics, Wayne State University School of Medicine; Professor, Department of Internal Medicine, Oakland University William Beaumont 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, Society for Experimental Biology and Medicine

Disclosure: Have a 5% or greater equity interest in: Secretory IgA, Inc. ; siRNAx, Inc.<br/>Received income in an amount equal to or greater than $250 from: siRNAx, Inc.

Chief Editor

Michael A Kaliner, MD Clinical Professor of Medicine, George Washington University School of Medicine; 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, Association of American Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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, Clinical Immunology Society

Disclosure: Received salary from CSL Behring for employment; Received ownership interest from CSL Behring for employment; Received consulting fee from America''s Health insurance plans for subject matter expert for clinical immunization safety assessment network acvtivity of cdc.

Sections Immunoglobulin G Deficiency
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Immunoglobulin G Deficiency Workup

Laboratory Studies

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