Allergy Asthma Respir Dis.  2016 May;4(3):225-229. 10.4168/aard.2016.4.3.225.

Intravenous immunoglobulin therapy in a selective IgG3 deficient patient with recurrent respiratory infections and asthma attacks

• Lee HY
• Yoon SW
• Kim Y
• Cho HJ
• Lee JY
• Gu KM
• Park TY
• Choi JC
• Shin JW
• Kim JY
• Park IW
• Choi BW
• Jung JW

• KMID: 2165087
• DOI: http://doi.org/10.4168/aard.2016.4.3.225

Abstract

The IgG subclass deficiency is defined as a significant decrease in the serum concentrations of one or more subclasses of IgG in a patient whose total IgG concentration is normal. IgG subclass deficiency can predispose to recurrent sinopulmonary infections. A 29-year-old female patient with a 4-year history of bronchial asthma presented with cough, sputum, dyspnea, and recurrent respiratory infections. She had frequently been treated with antibiotics and systemic steroids for recurrent respiratory infections and acute asthma exacerbations. Chest X-ray and computed tomography showed pectus excavatum and bronchial wall thickening without lung parenchymal abnormalities. On immunological evaluation, she was found to have a low serum IgG3, with normal total IgG concentration. Under diagnosis of selective IgG3 deficiency, she was started on monthly infusions of intravenous immunoglobulin (IVIG) therapy. The frequency and severity of respiratory infections and acute asthma exacerbations were markedly decreased during 3 years of IVIG therapy. Our case report suggests that a patient who has underlying selective IgG3 deficiency and asthma may benefit from IVIG therapy as this can significantly reduce the incidence and severity of recurrent respiratory infections and acute asthma exacerbations.

Keyword

IgG deficiency; Intravenous immunoglobulin; Asthma

MeSH Terms

Adult
Anti-Bacterial Agents
Asthma*
Cough
Diagnosis
Dyspnea
Female
Funnel Chest
Humans
IgG Deficiency
Immunization, Passive*
Immunoglobulin G*
Immunoglobulins*
Immunoglobulins, Intravenous
Incidence
Lung
Respiratory Tract Infections*
Sputum
Steroids
Thorax
Anti-Bacterial Agents
Immunoglobulin G
Immunoglobulins
Immunoglobulins, Intravenous
Steroids

Figure

• 

  Fig. 1 (A) Chest X-ray shows increased opacity in right lower lung field, probably due to pectus excavatum. (B) Paranasal sinus waters view shows no abnormality in paranasal sinuses. (C) High resolution computed tomography of chest reveals crowding of subsegmental bronchi, medial segment of right middle lobe, probably due to pectus excavatum and bronchial wall thickening without lung parenchymal abnormalities.

• 

  Fig. 2 Changes in duration of antibiotics and total dose of systemic steroids per year according to intravenous immunoglobulin (IVIG) treatment.

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