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Deficient for IgG1 and IgG3. Suspected low O2 sats. Bronchiastasis from recurrent chest infections. Remedy?

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Practicing since : 1999
Answered : 549 Questions
Hi Doc,

Where to start?

I have been very unwell for about 7 years now - but recently they have noticed that I am deficient in IgG1 and IgG3 and it looks like I might finally have a diagnosis as CVID they suspect that my Low O2 sats were from Bronchiastasis from recurrent chest infections and this has also made me borderline hypoxic, they also suspect that the massive joint and chest pains I have been having are from Autoimmune diseases - caused by Immune dysfunction due to Immunological deficiency - I definitely have classic Psoriatic Arthritis and possible Lupos as well as Gout.

My concern is that no one could work this out for years, it is only by chance that my Respiratory Physician looked back through my previous blood tests and found the low IgG1 and IgG3 results, he since did an antibody test to Diptheria / Tetenas which which showed that my immune system is not responding properly (still awaiting pnuemoccocil test as well) - that said I have not even seen an Immunologist (very hard to get into see one as they are sooo busy) but my respiratory doctor has told me to start on Intragram IVIG replacement therapy.

I think he is on the right track, however I want to be sure that other things could not have lowered my IgG results - ie with my massive joint issues, I am often on high dose prednisone 50mg and I have been on Sulphasalazine as well at the time of testing IgG - so could these have lowered it?

So my Questions are;

1/ Does Predinisone or Sulphasalazine lower immunoglobulan to the point of deficiency?
2/ Should I be seeing an Immunologist before going on IVIG therapy?
3/ Is there any disadvantage to going on SubQ IG Therapy for a larger person - I want to still play sport and I do not want a portacath?
4/ I will need some treatment for my rhuematalogical disorders - but obviously I need to lower Immune response in order to help with this issue - but lowering immune response will affect my ability to fight off infections - so how do you achieve both goals - and if I have to do both - what drug lowers Immune response less - ie what drug could I take for Psoriatic Arthritus that would be least damaging to my already low Immunoglobulan?

5/ I have tried Methotrexate and Sulphasalazine with limited result, but what about Humira - which will be best for me?

6/ What is life expectancy for people with CVID with moderate lung involvement?

7/ Did my autoimmune rheumatoid issues cause the lower IgG levels ( I don't flare up, I am constantly attacked with everyday joint involvement so perhaps my immune system is burnt out?) or did the lower IG levels make me acquire rheumatoid diseases?

8/ What are the chances of our children developing the disease issues I have - we have not had any yet but considering it?

9/ Do Rhuematological issues sometimes get better after IVIG therapy?

10/ Could my joint pains be from Bacteria - due to low IgG

11/ Are there any food allergies that can lower IG - I seem to react to certain foods like seafood etc?

Posted Fri, 11 Oct 2013 in Lupus
Answered by Dr. Divya Agarwal 24 hours later
Brief Answer:
CVID is an acquired immunodeficiency syndrome

Detailed Answer:
CVID is an acquired deficiency of immunoglobulins causing recurrent infections, autoimmune diseases and possibly malignancies.
prednisone or sulfasalazine generally do not produce such deficiencies.

It would definitely be better to see an immunologist before you start this therapy, as it is going to be a long term treatment and should be done under proper guidance.

there should not be any major disadvantage, a larger dose may be required.

treatment with Ig will probably benefit you with the arthritis as well.

As I stated people with low Ig are predisposed to RA , so that is probably the cause.

As this may be to some extent genetic, you need prepregnancy counselling with a geneticist before planning pregnancy.
rheumat issues generally become better with IVIG therapy

Food allergies are not related to Ig levels.

The prognosis really depends on the extent of organ involvement.
Above answer was peer-reviewed by
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