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Transient Hypogammaglobulinemia of Infancy

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Topic updated on 01/26/17 2:04am

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 of infancy (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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