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Updated: Aug 22 2019

Transient Hypogammaglobulinemia of Infancy

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  • Snapshot
    • An 8-month-old girl is brought to the pediatrician due to several episodes of ear infections and recently developed a cough over the past few months. She has been on several courses of antibiotics. The parents deny a family history of recurrent infections. Laboratory testing is remarkable for low IgG levels, with normal IgA, IgM, and IgE levels.
  • Introduction
    • Transient hypogammaglobulinemia ofinfancy (THI) is the delayed onset of normal immunoglobulins level, usually IgG
    • Pathophysiology
      • normal physiology
        • maternal IgG is slowly catabolized after birth
        • IgG is slowly synthesized in infant
        • IgG reaches physiologic level at 3 - 6 months
      • etiology of THI largely unknown
    • Epidemiology
      • transient hypogammaglobulinemia presents at 5-6 months of age
    • Associated conditions
      • may have increased risk for atopy
        • allergic rhinitis
        • atopic dermatitis
        • food allergies
  • Presentation
    • Symptoms
      • often asymptomatic
      • frequent pyogenic infections
      • frequent sinopulmonary infections
        • otitis media
        • sinusitis
        • upper respiratory infections
    • Physical exam
      • typically no findings
  • Evaluation
    • ↓ IgG
    • May also see ↓ IgA and IgM
  • Differential Diagnosis
    • Bruton's agammaglobulinemia
    • IgA deficiency
    • Common variable immunodeficiency
    • Other primary immunodeficiencies
  • Treatment
    • Antibiotics as needed in symptomatic patients
    • If severe, IVIG
      • can also be considered in those with poor antibody response to vaccines
  • Prevention, Prognosis, and Complications
    • Prognosis
      • very good
      • typically resolves by 2-6 years
    • Complications
      • Severe pyogenic infections
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