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Medication

Medication Summary

Medications are necessary when hypocalcemia or immunodeficiency is present. Treat patients with severely impaired T-cell function or profound lymphopenia prophylactically with trimethoprim/sulfamethoxazole, as directed by the immunologist. In patients with primary immune deficiencies, an immunologist should decide whether to initiate replacement therapy with intravenous (IV) immunoglobulin.

Calcium supplementation is necessary in patients with hypocalcemia. In rare cases in which calcium supplementation may not suffice, vitamin D may also be administered.

Class Summary

Surgically implanted allogeneic processed thymic tissue is intended to reconstitute immunity in children who are athymic.

Allogeneic processed thymus tissue (Rethymic)

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Indicated for immune reconstitution in pediatric patients with congenital athymia.

Class Summary

These agents are used prophylactically in patients with immunodeficiency.

Sulfamethoxazole and trimethoprim (Bactrim, Septra)

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This combination is used for prophylaxis. It inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid. Sulfamethoxazole/trimethoprim should be prescribed based on recommendations from an immunologist.

Class Summary

Hypocalcemia may occur, requiring supplementation with calcium. In patients with symptoms refractory to calcium, supplementation with a vitamin D analog may also be necessary.

Calcium carbonate (Oystercal, Caltrate)

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Calcium carbonate is used for the treatment and prevention of calcium depletion. Calcium moderates nerve and muscle performance by regulating the action potential excitation threshold. One gram of calcium carbonate equals 400 mg of elemental calcium. Calcium carbonate has higher oral bioavailability than other orally administered calcium salt products.

Calcitriol (Rocaltrol)

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This agent is a vitamin D analogue and the primary active metabolite of vitamin D-3. Calcitriol increases calcium levels by promoting the absorption of calcium in the intestines and the retention of calcium in the kidneys. Its use should be initiated only upon an endocrinologist's recommendation.

Calcium gluconate (Kalcinate)

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Calcium gluconate moderates nerve and muscle performance and facilitates normal cardiac function. It can initially be administered intravenously; a high-calcium diet can be used to maintain calcium levels. Some patients require oral calcium supplementation. The 10% IV solution provides 100 mg/mL of calcium gluconate, which equals 9 mg/mL (0.46 mEq/mL) of elemental calcium.

Ergocalciferol, vitamin D-2 (Drisdol)

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This vitamin D-2 analogue is converted in the liver to an active intermediate and then further converted to its most active form in kidneys. Ergocalciferol effectively increases renal reabsorption of calcium, intestinal absorption of calcium, and calcium mobilization from bone to plasma.

Questions

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Media Gallery

Mother and children with 22q11.2 deletion syndrome.
An African American girl with 22q11.2 deletion syndrome.
The same child as in the previous image, showing an asymmetrical crying face.

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Author

Erawati V Bawle, MD, FAAP, FACMG Retired Professor, Department of Pediatrics, Wayne State University School of Medicine

Erawati V Bawle, MD, FAAP, FACMG is a member of the following medical societies: American College of Medical Genetics and Genomics, American Society of Human Genetics

Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD Faculty, Division of Allergy/Immunology and Infectious Diseases, Department of Pediatrics, Saint Peter's University Hospital

Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Pediatric Research, Society for Mucosal Immunology

Disclosure: Nothing to disclose.

Acknowledgements

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Mark A Crowe, MD Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine

Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society

Disclosure: Nothing to disclose.

Daniel AC Frattarelli, MD, FAAP Senior Staff, Departments of Pediatrics and Emergency Medicine, Henry Ford Hospital

Daniel AC Frattarelli, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Clinical Pharmacology, and American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Sridhar Guduri, MD Consulting Staff, Allergy and Asthma Clinics of Ohio

Sridhar Guduri, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American College of Allergy, Asthma and Immunology

Disclosure: Nothing to disclose.

Iftikhar Hussain, MD Director of Allergy, Asthma, and Immunology Center, PC

Iftikhar Hussain, MD 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 Thoracic Society, and Association of Clinical Research Professionals

Disclosure: Nothing to disclose.

Suguru Imaeda, MD Chief of Dermatology, Yale University Health Services; Chief of Dermatology, West Haven Veterans Affairs Medical Center; Assistant Professor, Department of Dermatology, Yale University School of Medicine

Suguru Imaeda, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Connecticut State Medical Society, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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: Alcon Consulting fee Consulting; Teva Consulting fee Consulting; Meda Honoraria Speaking and teaching; Ista Consulting fee Consulting; sunovian Consulting fee Consulting; dey Honoraria Review panel membership

Charles H Kirkpatrick, MD

Charles H Kirkpatrick is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Physicians, American Federation for Clinical Research, American Society for Clinical Investigation, and Clinical Immunology Society

Disclosure: Dyax Consulting fee Consulting

C Lucy Park, MD Head, Division of Allergy, Immunology, and Pulmonology, Associate Professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine

C Lucy Park, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Medical Association, Chicago Medical Society, Clinical Immunology Society, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-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.

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

Disclosure: Medscape Salary Employment

Patrick Htain Win MD, President/Director, Allergy, Asthma and Immunology Center, SC; Director, The Clinical Research Center of Southern Illinois, LLC

Patrick Htain Win is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, and Joint Council of Allergy, Asthma and Immunology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

DiGeorge Syndrome Medication

Medication Summary

Regenerative Therapy

Class Summary

Allogeneic processed thymus tissue (Rethymic)

Allogeneic processed thymus tissue (Rethymic)

Antibiotics

Class Summary

Sulfamethoxazole and trimethoprim (Bactrim, Septra)

Sulfamethoxazole and trimethoprim (Bactrim, Septra)

Vitamin and Mineral Supplements