From the Guidelines
IgG deficiency should be treated with immunoglobulin replacement therapy, administered either intravenously (IVIG) at 400-600 mg/kg every 3-4 weeks or subcutaneously (SCIG) at 100-200 mg/kg weekly, to reduce the incidence of pneumonia and acute sino-pulmonary infections, as shown in a study published in Thorax in 2019 1.
Treatment Overview
The goal of treatment is to improve clinical outcomes by providing the missing antibodies and preventing serious infections.
- Patients should practice preventive measures like good hand hygiene, avoiding sick contacts, and promptly treating infections.
- For recurrent bacterial infections, prophylactic antibiotics may be prescribed, such as azithromycin 250-500 mg three times weekly or trimethoprim-sulfamethoxazole 160/800 mg daily.
- Vaccination against pneumococcal disease, influenza, and other pathogens is recommended, though response may be suboptimal.
Monitoring and Adjusting Treatment
Regular monitoring of IgG trough levels (targeting >500-700 mg/dL) and clinical response is essential to adjust dosing.
- The therapy doesn't cure the deficiency but effectively manages symptoms and prevents serious infections that could lead to permanent organ damage.
- High doses of IVIG are associated with reduced incidence of acute sino-pulmonary infections, as shown in a study published in the Journal of Allergy and Clinical Immunology in 2015 1.
Specific Considerations
- Patients with X-linked agammaglobulinemia (XLA) should be managed aggressively with antimicrobials, IgG replacement, and careful attention to pulmonary status, as stated in a study published in the Journal of Allergy and Clinical Immunology in 2015 1.
- A diagnosis of IgG subclass deficiency should be considered for patients with recurrent infections, low IgG subclass levels, and normal total concentrations of IgG, IgM, and IgA, as stated in a study published in the Journal of Allergy and Clinical Immunology in 2015 1.
From the Research
IGG Deficiency Treatment
- Immunoglobulin replacement therapy is the most effective treatment to prevent recurrent infections in antibody deficiency patients, including those with IGG deficiency 2.
- The decision to initiate immunoglobulin replacement therapy in patients with IGG deficiency depends on various factors, including the patient's infectious history, vaccine response, and presence of bronchiectasis 2.
- Both subcutaneous and intravenous routes of administering IgG can be effective and well tolerated, and treatment regimens can be individualized to provide optimal medical and quality-of-life outcomes 3.
Treatment Options
- Immunoglobulin replacement therapy can be administered subcutaneously or intravenously, and both routes have advantages and disadvantages 3, 4.
- Subcutaneous IgG therapy has been shown to be safe, with few adverse effects, and can lead to high serum IgG levels and good protection against infections 4.
- Antibiotic prophylaxis can also be effective in preventing infections in patients with IGG deficiency, and may be considered as an alternative to immunoglobulin replacement therapy 5.
Indications for Treatment
- Immunoglobulin replacement therapy is indicated for patients with primary immunodeficiency, including those with IGG deficiency, who have a history of recurrent infections and impaired antibody production 2, 6.
- The decision to continue treatment with immunoglobulin replacement therapy should be based on regular evaluation of the patient's clinical and laboratory response to treatment 6.