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What does low IgG subclass level with low total IgG mean?

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Posted on Thu, 17 Jul 2014
Question: #### DO NOT ANSWER THIS QTN UNLESS YOU ARE AN IMMUNOLOGIST PLEASE###

Hello Doc,

I have been diagnosed with CVID - however only IgG1 and IgG3 were low, this was only ever found once and I was on Prednisone and Sulphasalazine at the time.

I have chronic chest pain and blood comes up on my pillow sometimes in the morning, I have had gut disturbances that required a fundiplication operation.

I do not believe i have ever been sick more than the average person - however they believe this and my autoimmune diseases - Psoriatic Arthritis and possible Lupus are a result of this deficiency.

I had a Vaccine challenge, but I am pretty sure that got botched up - I was supposed to get Pnuemacoccil and Tetanus challenge, - but I only received one needle (pretty sure that was Tetanus) - so i only got one - the second blood test to check response for Tetanus got lost somewhere so that result was not conclusive, but the the Pnuemacocil showed no antibody response.... however I suspect I was never given it in the first place.

I have been on Intragram P IVIG for 12 months, starting on 20mg and going up to 30mg, I weigh 118kg so it is not a lot.

I want to be sure that the Prednisone and Sulfasalzine as well as my Autoimmune diseases (which are quite severe) did not cause the low IgG1 and IgG3 results

But I am not sure how I can re-test - from what I have read i would need to be off the IVIG for four months and then do another vaccine challenge - is this correct?

My IVIG is funded so I need to be very careful in requesting to go off the IVIG as I may not get back on it easily.

I also am not sure how I am supposed to live, I read a lot about people with CVID and they cant go outside and garden etc... but I am only subclass deficient - so I am unsure - the IVIG seems to help with the Autoimmune disease as it is not as painful.

I dont suffer flares - I get constant pain especially, Lungs, gut, chest, feet, ankles, knees elbows etc.. Is till play soccer three times a week.. but mostly in severe pain.

I have tried a bunch of immune suppressing drugs and will soon start Arava

I seem to have inflamed arteries too - according to blood tests and the blood in my lungs is caused from changing cells that show sever constant inflammation (squamous metaplasia).

I once had a 2 week course of Antiretrovirals - but the true start of ALL my illness happend in 2006 when I was vaccinated for MMR and others as I traveled to Germany to see the Soccer world cup - prior to this I never saw Doctors and I was playing professional sport part time - over the last 8 years it has destroyed me - I am positive that something is in my blood causing everything to be inflamed - I also had the Antrax injection and pills when in the Army at the time of the Gulf war.

I guess I want to know how I can check that i DO have an Immune Deficiency and hear your opinion on things?

In Blood work I tend to have high Uric Acid, High HDL, High CRP (only sometimes) High Plasma Fibrinigen - Low Vitamin B - Borderline thyroid - But my biggest issue is very low Po2 in my Arterial Blood Gas results and low O2 saturation constantly - especially at rest

Thanks in Advance
doctor
Answered by Dr. Sujoy Khan (5 days later)
Brief Answer:
Possible drug induced low IgG - CVID also possible

Detailed Answer:
Dear XXXXXXX
Welcome to Healthcare Magic and thank you for writing to us.

The Low IgG subclass level together with low total IgG would mean you are not producing enough IgG (immunoglobulin G), and recurrent infections plus decreased polysaccharide vaccine responses fits into the diagnosis of CVID.
However, the polysaccharide vaccine response test seems to have been lost in translation so the diagnosis is not quite established.
Being on immunosuppressive therapy would also lower IgG levels, so if the diagnosis requires to be established, you will have to be off IVIG replacement therapy for 3 months.
This would be an academic exercise, so if getting funding the 2nd time round for IVIG will not be a hassle, this is a reasonable option. I would try this option if your trough IgG level is quite high (i.e., always above 8-9 mg/L).

With the heart side of things, I would exclude cardiac amylodosis by a series of tests:
1. ECHO
2. Serum free light chains
3. Amyloid study
Amylodosis becomes a possibility here due to the chronic 'inflammatory' nature of immunodeficiency diseases, only if commoner things such as COPD, Bronchiectasis, GL-ILD have been excluded.


Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sujoy Khan

Allergist and Immunologist

Practicing since :1999

Answered : 584 Questions

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What does low IgG subclass level with low total IgG mean?

Brief Answer: Possible drug induced low IgG - CVID also possible Detailed Answer: Dear XXXXXXX Welcome to Healthcare Magic and thank you for writing to us. The Low IgG subclass level together with low total IgG would mean you are not producing enough IgG (immunoglobulin G), and recurrent infections plus decreased polysaccharide vaccine responses fits into the diagnosis of CVID. However, the polysaccharide vaccine response test seems to have been lost in translation so the diagnosis is not quite established. Being on immunosuppressive therapy would also lower IgG levels, so if the diagnosis requires to be established, you will have to be off IVIG replacement therapy for 3 months. This would be an academic exercise, so if getting funding the 2nd time round for IVIG will not be a hassle, this is a reasonable option. I would try this option if your trough IgG level is quite high (i.e., always above 8-9 mg/L). With the heart side of things, I would exclude cardiac amylodosis by a series of tests: 1. ECHO 2. Serum free light chains 3. Amyloid study Amylodosis becomes a possibility here due to the chronic 'inflammatory' nature of immunodeficiency diseases, only if commoner things such as COPD, Bronchiectasis, GL-ILD have been excluded. Best Wishes.