Low Or Deficient Iga

[looneymom]

I have part of my son's immune testing results. He saw his neurologist today and had blood work drawn for PANDAS test. Plus he had the shot for the vaccine challenge. So it's been a long day. I know we cannot give medical advice but I have a feeling some of you may be more familiar with some of this these test results. My son's IGA was 56 but the range is 71-263. Is this just low or considered a deficiency? IGG, IGM, and IGE levels are all within the normal range. Also his IGG subclasses were measured. His IGG1 and 2 were in normal range but IGG3 was 49 (28-125 normal range) and IGG4 was 27(0-136 normal range). All of my son's Pneumo Ab types came back way below the normal reference range. So today my son was given the Pneumo 23 vaccine. In 4 weeks he will have blood drawn to see if his body made any antibodies.

The neurologist that my son is seeing can actually treat for PANDAS. This test should be back in about 4 weeks. So maybe we won't have to go out of state for treatment if PANDAS is the cause. She is concerned about the IGA and mentioned this might could be a deficiency. Are there other test that should be run? Or would this be the reason for doing the vaccine challenge test. Feeling just a tad overwhelmed by all this information. Also the neurologist said that IVIG might not be the first lines of meds because of the low IGA. Feel free to share your experiences and what questions I should be asking the doctors at this point.

[Guest Alex]

I just had a similar conversation with my dr the other day as he has ordered IVIG for me to try.

Indeed, IVIG shouldn't be used for people with a low IgA as they have a higher chance of developing anaphylactic shock during the treatment. Also my understanding is that other blood products are off limits for those with a low IgA. The other thing you may want to keep in mind is that IVIG treatments are still an option but the immunoglobulin used for the infusions should not contain any IgA. You might want to ask about that option if indeed you believe he might benefit from it.

It's possible that this is actually an inherited condition (chances are you or your husband have it as well) but it's also possible to be drug induced. I don't know what drugs may cause this though. Another question for your dr i guess.

Also, I'm pretty sure that there are no particular symptoms associated with a low IgA, but some may have more frequent upper respiratory infections, bronchitis, sinusitis, pneumonia or asthma.

I really have no idea what tests might bring more info for the drs, or why the neuro ordered that vaccine challenge, but it does sound like they know what they're doing.

Hope you get some answers soon.

Hang in there.

Alex

[Katybug]

I know this is all overwhelming but at least it sounds like you might be getting closer to an underlying cause for your son's issues, and for that, I am happy for your family. I had the vaccine challenge which was not ordered due to any of my Ig numbers. My immunologist said it is a general test to see if your immune system is working at all. I had almost no pneumonia antibodies because I had never had the vaccine or infection and he said that's exactly what he'd expect to see. Then I had the vaccine and my antibody numbers were in the normal range. So, we knew my ability to fight infections was in a healthy state. I can't help with the IgA except to say that when I get my labs, I go to labtestsonline.com and look up the test. The site will usually give you a list of differential diagnoses for abnormal test results. I use that list to start my research.

[arizona girl]

HI LM,

Alex posted first with some good info for you. I know I've posted to you before but I don't remember what I said. Even though this is confusing right now, you all are making progress and now have some results to work with. It sounds like your doctor knows what she is doing. BTW does he get infections of any kind, if so what kinds? The vaccine challenge is going to show where his immune system is responsive and where it isn't. So good test, it will help direct treatment. I have cvid with low igg and at one point no igm. Most of the ivig products are almost 100% IGG. So it wouldn't replace deficient iga and like alex pointed out there can sometimes be a reaction if there is any iga in the product, as one of the reasons the iga can be low is due to autoantibodies against it. So it would attack any iga that enters the body. Not everyone reacts and if he is getting a lot of infections it could be used with caution, I think also the subq form doesn't create the same kind of reactions.

Here is a link that discusses this in greater depth: http://primaryimmune.org/about-primary-immunodeficiencies/specific-disease-types/selective-iga-deficiency/

Try not to be too overwhelmed, in time you will understand the mechanisms going on, and will be in a good position to help make the right treatment choice for your son. With the results and the knowledge you gain, there is hope that you will better be able to help your son manage is illnesses.

[looneymom]

My son has had many ear, sinus, croupy cough and walking pneumonia infections in the past years. When the doctor thought it looked like strep or a sinus infection, he would go ahead and treat my son with an antibiotic. The doctor would always do a rapid strep test and it would come back negative. However, I always worried about giving my son the antibiotic when the strep did not show up. Then there were times, I would have to take my son back to the doctor because his ears still hurt and he would have to be placed on a second round of antibiotics. Up until the third grade, it was not unusual to be taking my son to the doctor for an illness every 2-3 months. I was told he would outgrow the ear and sinus infections but the croupy cough should have been someone's cue. Even MAYO thought it was strange for an 11 year old boy to have this. The doctor examined my son and diagnosed it as spasmodic croup with striders in December of 2011 while we were there for a visit.

I started looking at my son's testing again for the pneumonia antibodies. His pneumonia type 23 antibody was <0.1. The normal range is >1.3. This type of pneumonia is caused by strep. My son was just given the pneumonia 23 vaccine yesterday to see if his antibodies would come up. PANDAS is also caused by strep. I can't wait to get the results of the PANDAS testing and Vaccine challenge. I wonder if I have found the underlying cause of his POTS. Too bad I have to wait 4-6 weeks to get back test results. Hope everyone is having a symptom free day and never give up searching for your underlying cause of POTS.

[arizona girl]

Oh Lm, I know this has been tough! It is surprising how often these immune deficiency diseases are missed. Any one that knows enough about it, would see that it is obvious given your son's medical history. The good news is he has survived all these infections with this on board. I hope you took time to go to website I sent you and read more. Read about the x linked male forms found there too and see if any of them fit better.

When an infection is on board the heart can race enough to be considered pots.

At this point I wouldn't worry about the antibiotics, when you have a form of this, antibiotics are your friend. They just need to be rotated to help avoid any potential resistance to one. Infection must be treated aggressively, when one has this defect. Especially if he ends up not being a candidate for ivig or subq.

One of the things I do because I don't run much of a fever if one at all, when I have a suspected infection, is I have a standing cbc order, to keep an eye on my WBC. If I have infection symptoms and it's elevated, we go right to a rocephine shot or two, to knock it down. We don't even try to figure out where the infection is. Between the ivig, other autoimmune treatments and antibiotics when necessary, I'm being managed fairly well. I still feel like crap often, but not enough to do much else about that.

It is interesting that you mentioned croup. My brother had that terrible as a child. I also see signs of this illness in my sisters. They don't have insurance, so they haven't been screened yet. I can't help but feel there is a genetic bases to much of this.

[looneymom]

Hi AG,

The website has been such a big help and it's easy to understand. Since I am understanding my son's test results, I have been going through more of the website. I have also been following the last post on IVIG treatment. So much information to consider. Thanks for posting the website.

[jpjd59]

LM:

Sounds like you are finally getting closer to getting an answer. It pays off to be a persistent mom! Hope your son will start feeling better soon.

Pam