Serum immunoglobulins and immunoglobulin G subclasses with recurrent wheezing

Transient low IgG4 levels cause recurrent wheezing requiring multiple hospitalizations in infancy

OBJECTIVES

To investigate whether the immunoglobulin G (IgG4) subclass is associated with recurrent wheezing and/or asthma in infants.

SUBJECTS AND METHODS

From April 2015 to March 2016, 77 infants under 3 years old who attended our hospital were enrolled in four groups (Group 1, controls; Group 2, infants with recurrent wheezing and multiple hospitalizations despite starting inhaled corticosteroids [ICS]; Group 3, infants with recurrent wheezing and without hospitalization after starting ICS; Group 4, allergic infants without wheezing). The relationship between IgG subclasses, especially IgG4, and recurrent wheezing resistant to ICS and requiring multiple hospitalizations in infants was examined.

RESULTS

The serum IgG, IgM, IgA, IgG1, IgG2, and IgG3 levels did not differ significantly among the four groups. The IgG4 level in Group 2 infants (3.1 ± 0.2 mg/dl) was significantly lower than in Groups 1, 3, and 4 (9.9 ± 8.0, 8.4 ± 6.1, and 23.4 ± 18.0 mg/dl). Of the 16 infants in Group 2, 10 could be followed to age 6 years. Nine of them had no recurrent wheezing at 6 years without medication. In addition, their IgG4 levels at age 6 years (16.1 ± 7.1 mg/dl) were significantly increased from those in infancy (3.0 ± 0.1 mg/dl).

CONCLUSION

A transient low IgG4 level in infancy might cause recurrent wheezing and/or asthmatic symptoms in infants, and it may be one of the types of early transient wheezing.

Isolated immunoglobulin G4 subclass deficiency in a child with bronchiectasis

Immunoglobulin G4 subclass deficiency is the most common IgG subclass deficiency, followed by immunoglobulin G2 deficiency. However, IgG2 deficiency is the most common IgG subclass deficiency associated with recurrent infections. Immunoglobulin G4 subclass deficiency occurs in association with other isotype deficiencies. Isolated IgG4 deficiency, however, is much less common. Although respiratory tract infections are the most common manifestation in isolated IgG4 deficiency, other mucosal surfaces may also be affected in IgG4 deficiency leading to diarrhea and recurrent giardiasis. The authors herein report a case of isolated immunoglobulin G4 subclass deficiency in a young girl presenting with bronchiectasis. The diagnosis was established after ruling out other causes of secondary and primary immunodeficiency.

Montelukast in early childhood asthma. Predict value of IgG in clinical reply in children 2 to 5 years old?

BACKGROUND

According to current knowledge, asthma is basically an inflammatory process. Its causes and physiopathological mechanisms are various. The final result is a recurrent obstructive bronchial process, with sibilants and/or dypnea, which causes an upset in functional respiratory tests, among which the maximum respiratory peak flow meter diminished for the age, sex, and height of patient.

AIMS

Our aim is to evaluate if response to treatment with Montelukast has any link with immnuloglobin values (IgG, IgA, IgM, IgE) at start of treatment.

MATERIALS AND METHODS

Included in the study were 32 children, of whom 2 did not begin and 1 who did not provide personal data. There were 29 patients in total, 11 girls and 18 boys. Each made three visits: first where they were instructed, together with their parents, in how to manage the meter and where they received the peak flow meter, Vitalograph, and personal data sheet, where personal and family medical history were noted. The second visit was after 4 weeks, for a clinical assessment and the third visit after 8 weeks. The value register of the PEF would be made morning and night, noting the highest value of three measurements. IgG, IgA, IgM, IgA values were quantified before treatment began. The statistic package STATA 2001 was used in the treatment of data statistics.

RESULTS

Our between the value reached by the PEF after treatment and the IgG values at the beginning of treatment (0.712). In lesser measurement for IgA values (0.660). For each 100 mg/ml of increase in the value of IgG, an increase of 10 l/min in the PEF measurement before and following treatment with Montelukast was produced.

CONCLUSIONS

IgG values increase with age. Children with a greater IgG value at the beginning of treatment reached higher PEF values after same. It is not known if the results would be similar with another type of treatment and the way in which IgG influences the results. What appears to be confirmed by available studies is that this relation is found in a group of small children, the aim of our study.