Efficacy of intravenous immunoglobulin in the prevention of pneumonia in patients with common variable immunodeficiency

doi:10.1067/mai.2002.124999

Journal of Allergy and Clinical Immunology

Volume 109, Issue 6, June 2002, Pages 1001-1004

https://doi.org/10.1067/mai.2002.124999 Get rights and content

Abstract

Background: Common variable immunodeficiency (CVID) is a primary immune disorder characterized by antibody deficiency and a decrease in serum IgG and IgA, IgM, or both levels at least 2 SDs below the mean for age and not attributed to other known immunologic disorders. These patients often present with frequent and severe episodes of pneumonia before diagnosis. The standard treatment, intravenous immunoglobulin (IVIG), has been available for the past 20 years. No large-scale study has compared the incidence of pneumonia in these patients before and after IVIG treatment. Objective: The aim of this study was to document the effectiveness of intravenous immunoglobulin treatment on the incidence of pneumonia in patients with CVID. Methods: We performed chart reviews and interviews of patients with laboratory-confirmed CVID seen at our clinical center. The number of episodes of pneumonia was documented before and after treatment with immunoglobulin replacement therapy. Results: The histories of 50 patients were reviewed (mean current age, 42 ± 16.3 years; age range, 10-78 years; 20 male and 30 female patients). Forty-two (84%) of the 50 patients with CVID had pneumonia at least once before receiving immunoglobulin treatment, and 11 of 42 of these patients had multiple episodes. After treatment with gamma globulin over a mean period of 6.6 ± 5.2 years (range, <1-20 years), the number of patients experiencing pneumonia significantly decreased to 11 (22%) of 50. In most cases these patients had pneumonia in the first year of immunoglobulin treatment. Conclusion: The treatment of CVID with IVIG significantly reduces the incidence of pneumonia. (J Allergy Clin Immunol 2002;109:1001-4.)

Section snippets

Patients

Mount Sinai Medical Center has been a referral center for patients with primary immunodeficiency, and 280 patients with CVID have been seen over a period of 15 years. Data on these patients are maintained and assigned a number at the time of referral. For this study, the charts of the 50 most recently referred patients have been reviewed. All of the 50 patients met the definition for CVID.6, 7 Antibody deficiency was verified by means of decreased antibody production to 2 or more vaccines,

Episodes of pneumonia before treatment with IVIG

Forty-two (84%) of 50 patients had at least one episode of pneumonia verified on chest radiography before diagnosis of CVID and IVIG treatment, whereas the remaining 8 (16%) had never had pneumonia. Of these 42 patients, the number of episodes of pneumonia could be determined for 31. Fifteen (48%) of these 31 patients had one episode of pneumonia, 5 patients had 2 episodes, 6 had 3 episodes, 1 had 4 episodes, and the rest had more than 5 episodes. For these 31 subjects, the average number of

Discussion

Pneumonia is common in patients with CVID. Forty-two (84%) of 50 patients with CVID had at least one episode of pneumonia before diagnosis. Watts et al¹⁰ found that 28 (87.5%) of 32 patients with CVID (adults and children) had an average of 3 or more episodes of pneumonia each, and 14 had bronchiectasis over a period of 27 years, which included immunoglobulin pretreatment and treatment years. In another study 41 (75%) of 55 patients with CVID had at least one episode of pneumonia before

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^☆: Supported by the Immune Deficiency Foundation (Towson, Md), National Institutes of Health grants AI46732 and AI48693, and Food and Drug Administration grant 001679.

^☆☆: Reprint requests: Charlotte Cunningham-Rundles, MD, PhD, Department of Clinical Immunology, 1425 Madison Ave, The Mount Sinai School of Medicine, New York, NY 10029.

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Basic and Clinical ImmunologyEfficacy of intravenous immunoglobulin in the prevention of pneumonia in patients with common variable immunodeficiency☆,☆☆

Abstract

Section snippets

Patients

Episodes of pneumonia before treatment with IVIG

Discussion

Blood

Clin Immunol

Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Pediatr

Lancet

J Allergy Clin Immunol

Report of a WHO Scientific Group

Clin Exp Immunol

Basic and Clinical Immunology
Efficacy of intravenous immunoglobulin in the prevention of pneumonia in patients with common variable immunodeficiency☆,☆☆