TY - JOUR
T1 - Practical guidance for the diagnosis and management of secondary hypogammaglobulinemia
T2 - A Work Group Report of the AAAAI Primary Immunodeficiency and Altered Immune Response Committees
AU - Otani, Iris M.
AU - Lehman, Heather K.
AU - Jongco, Artemio M.
AU - Tsao, Lulu R.
AU - Azar, Antoine E.
AU - Tarrant, Teresa K.
AU - Engel, Elissa
AU - Walter, Jolan E.
AU - Truong, Tho Q.
AU - Khan, David A.
AU - Ballow, Mark
AU - Cunningham-Rundles, Charlotte
AU - Lu, Huifang
AU - Kwan, Mildred
AU - Barmettler, Sara
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2022/5
Y1 - 2022/5
N2 - Secondary hypogammaglobulinemia (SHG) is characterized by reduced immunoglobulin levels due to acquired causes of decreased antibody production or increased antibody loss. Clarification regarding whether the hypogammaglobulinemia is secondary or primary is important because this has implications for evaluation and management. Prior receipt of immunosuppressive medications and/or presence of conditions associated with SHG development, including protein loss syndromes, are histories that raise suspicion for SHG. In patients with these histories, a thorough investigation of potential etiologies of SHG reviewed in this report is needed to devise an effective treatment plan focused on removal of iatrogenic causes (eg, discontinuation of an offending drug) or treatment of the underlying condition (eg, management of nephrotic syndrome). When iatrogenic causes cannot be removed or underlying conditions cannot be reversed, therapeutic options are not clearly delineated but include heightened monitoring for clinical infections, supportive antimicrobials, and in some cases, immunoglobulin replacement therapy. This report serves to summarize the existing literature regarding immunosuppressive medications and populations (autoimmune, neurologic, hematologic/oncologic, pulmonary, posttransplant, protein-losing) associated with SHG and highlights key areas for future investigation.
AB - Secondary hypogammaglobulinemia (SHG) is characterized by reduced immunoglobulin levels due to acquired causes of decreased antibody production or increased antibody loss. Clarification regarding whether the hypogammaglobulinemia is secondary or primary is important because this has implications for evaluation and management. Prior receipt of immunosuppressive medications and/or presence of conditions associated with SHG development, including protein loss syndromes, are histories that raise suspicion for SHG. In patients with these histories, a thorough investigation of potential etiologies of SHG reviewed in this report is needed to devise an effective treatment plan focused on removal of iatrogenic causes (eg, discontinuation of an offending drug) or treatment of the underlying condition (eg, management of nephrotic syndrome). When iatrogenic causes cannot be removed or underlying conditions cannot be reversed, therapeutic options are not clearly delineated but include heightened monitoring for clinical infections, supportive antimicrobials, and in some cases, immunoglobulin replacement therapy. This report serves to summarize the existing literature regarding immunosuppressive medications and populations (autoimmune, neurologic, hematologic/oncologic, pulmonary, posttransplant, protein-losing) associated with SHG and highlights key areas for future investigation.
KW - B-cell–targeted therapy
KW - CD19 CAR-T-cell therapy
KW - Secondary hypogammaglobulinemia
KW - autoimmunity
KW - immunosuppression
KW - immunosuppressive medication
KW - ocrelizumab
KW - protein loss
KW - protein-losing enteropathy
KW - rituximab
KW - solid organ transplant
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U2 - 10.1016/j.jaci.2022.01.025
DO - 10.1016/j.jaci.2022.01.025
M3 - Article
C2 - 35176351
AN - SCOPUS:85127308302
SN - 0091-6749
VL - 149
SP - 1525
EP - 1560
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 5
ER -