Immunosuppression in Patients With Primary Immunodeficiency-Walking the Line
Allergy and Immunology
The Journal of Allergy and Clinical Immunology. In practice
Individuals with primary immunodeficiency (PIDD) experience not only infectious complications but also immune dysregulation leading to autoimmunity, inflammation, and lymphoproliferative manifestations. Management of these complications often requires treatment with additional immunosuppressive medications, which pose an additional risk of infectious complications. Immunosuppression in individuals with PIDD therefore requires careful assessment and consideration of risks and benefits. Medications should be closely monitored, and strategies for risk mitigation of adverse events considered, such as exposure reduction, appropriate vaccination, use of antibiotics/antivirals, and optimization of immunoglobulin replacement therapy. In a subset of individuals who are not tolerating immune modulation or experiencing disease progression despite appropriate interventions, hematopoietic stem-cell transplantation is a management option.
Medical Subject Headings
Humans; Immunosuppression Therapy; Hematopoietic Stem Cell Transplantation (adverse effects); Vaccination
Mustafa, S. S., Rider, N. L., & Jolles, S. (2022). Immunosuppression in Patients With Primary Immunodeficiency-Walking the Line. The Journal of Allergy and Clinical Immunology. In practice, 10 (12), 3088-3096. https://doi.org/10.1016/j.jaip.2022.08.025