A second look at secondary hypogammaglobulinemia

Authors

Rose Monahan, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco Medical Center, San Francisco, California.
Iris M. Otani, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco Medical Center, San Francisco, California.
Heather K. Lehman, Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
S Shahzad Mustafa, Rochester Regional HealthFollow

Department

Allergy and Immunology

Document Type

Article

Publication Title

Annals of Allergy, Asthma & Immunology

Abstract

Hypogammaglobulinemia is defined as a reduced immunoglobulin level, which can be either primary due to inborn errors of immunity or acquired in the setting of poor antibody production or increased antibody loss. Secondary hypogammaglobulinemia (SHG) should be considered in patients with a history of immunosuppressive therapy, transplant, protein loss syndromes, certain autoimmune conditions, and malignancies, as it can be associated with increased infectious risk. Appropriate history and lab-based screening in these populations can identify SHG allowing treatment and close monitoring as appropriate. Ideally, treatment focuses on control of the underlying condition or removal of iatrogenic causes of SHG. However, in many cases, treatment of the underlying condition does not reverse SHG or immunosuppressive therapy cannot be discontinued without significant risk to the patient. For these patients, strategies for risk mitigation against infectious complications include vaccination, antibiotic prophylaxis, and immunoglobulin replacement therapy. This report aims to summarize the existing and emerging data in the evaluation and management of SHG and highlight areas that require further investigation.

First Page

269

Last Page

278

DOI

10.1016/j.anai.2024.12.003

Volume

134

Issue

3

Publication Date

3-1-2025

Medical Subject Headings

Humans; Agammaglobulinemia (complications, immunology); Immunosuppressive Agents (therapeutic use, adverse effects); Autoimmune Diseases (immunology, diagnosis); Immunoglobulins, Intravenous (therapeutic use)

PubMed ID

39674275

Recommended Citation

Monahan, R., Otani, I. M., Lehman, H. K., & Mustafa, S. S. (2025). A second look at secondary hypogammaglobulinemia. Annals of Allergy, Asthma & Immunology, 134 (3), 269-278. https://doi.org/10.1016/j.anai.2024.12.003