Advertisement
 
Skip navigation links
About Us
Members
Fellows in Training
Allied Health Professionals
Alliance
Patients & Public
ACAAI Foundation
Newsroom
Sponsors
Annual Meeting
Skip navigation links
About Us
About Us Home Page
The Specialty
American Medical Association Code of Ethics
Membership Categories | Membership in ACAAI
Become a Member
Become an International Affiliate Member
College History, Leadership & Awards
ACAAI Privacy Policy
ACAAI Terms of Use
Contact Us
Non-Members Online Store
iCAALL
Medical Student Resources
Members
Member Directory
ACAAI Leadership
Annual Meeting
Nationwide Asthma Screening Program
CME/MOC Center
Joint Task Force of Practice Parameters
College History: Leadership & Awards
Letters to the Web Editors
Meetings and Events Calendar
Job Source
Fellows in Training
FIT Home Page
CME/MOC Center
FIT Become a Member
FIT Corner Questions
Meetings and Events
Member & Patient-Related Organizations
Nomination Procedures
FITs Unite in Baltimore for Education and Networking
Resources help FITs prepare for the ABAI exam
Allied Health Professionals
Allied Health Home Page
Annual Meeting
Ask the Allergist
Patient Frequently Asked Questions
Member & Patient Related Links
Meetings & Events Calendar
Become a Member
Alliance
Alliance Home Page
About the ACAAI Alliance
Annual Meeting
Meetings & Events Calendar
Become a Member
Alliance Calling all Photo Buffs!
Patients & Public
ACAAI Foundation
ACAAI Foundation Home Page
Foundation News
Donor Honor Roll
ACAAI Foundation Tithe-A-Talk Program
Honor and Memorial Gifts
Newsroom
News Room Home
Annual Meeting Media
News Releases
America Faces Allergy/Asthma Crisis-The Brochure
America Faces Allergy/Asthma Crisis-The Report
About Us
ACAAI Leadership
ACAAI Initiatives
Asthma Fact Sheet | Basic Asthma Information
Allergy Fact Sheet | Basic Types and Prevalence
Annual Meeting
ACAAI - Faces Facets Allergy Immunology 2014
Benefits
Al Jarreau
Named Lectures
Practice management, literature review and more for allied health professionals
Board Review

Questions During Workup of Isolated IgM Deficiency

Q. I am evaluating a 20-month-old male for isolated IgM deficiency, incidentally discovered by his pediatrician during an evaluation for failure to thrive. IgA and IgG levels are both appropriate for age. With exception of poor growth, he has been a very well child. He has been seen on only one occasion for an ill visit. At approximately 12mos of age he was diagnosed with a suspected viral upper respiratory infection. He has otherwise had only well child visits. His immunizations are up to date, and he has achieved all appropriate developmental milestones.

As part of my evaluation, I have obtained IgM isoantibodies (isohemagglutinins). The patient has type O+ blood. Both anti-A and anti-B isohemagglutinins are appropriately present. I additionally obtained titers to rubeola (measles), mumps, and rubella. Rubeola, mumps, and rubella titers all demonstrate specific IgG. However, the patient's rubeola IgG is reported as 60 AU/mL, while the reference range for a positive titer is >120 AU/mL.

What are the manifestations of an isolated IgM deficiency, and what should I recommend to the family with regard to rubeola vaccination?

A. Selective IgM deficiency is an uncommon disorder defined by decreased IgM with normal levels of other immunoglobulin classes. Clinical manifestations may be highly variable. In a 2009 review, clinical manifestations among the patient population studied included increased susceptibility to infections, atopic disease, and autoimmune disease. Associated laboratory abnormalities included abnormalities in IgG subclasses, lymphocyte subsets, lymphocyte proliferative responses, and impaired specific antibody responses to pneumococcal antigens.1

Between 2% and 5% of people do not develop measles immunity after the first dose of the MMR vaccine.2 The purpose of the two-dose MMR vaccination schedule currently recommended by the ACIP is to produce immunity in the small proportion of patients who do not respond to one or more of the components of the first dose.3 The second dose of MMR is typically given at 4-6 years of age for two reasons: the risk of measles is higher in school-age children than in preschool children, and children typically have an immunization visit between 4-6 years of age for other school-entry vaccines.4 However, a second dose of MMR may be given as early as 28 days after the first MMR dose and be counted as a valid dose if both doses were given after the child's first birthday.3 Merck no longer produces single-antigen rubeola, mumps, or rubella vaccines for the U.S. market. Therefore, a second dose of MMR vaccine would be recommended here, and a rubeola post- immunization titer obtained in 4-8 weeks.

1 (Yel L, Ramanuja S, Gupta S. Clinical and Immunological Features in IgM Deficiency. Int Arch Allergy Immunol. 2009;150(3):291-8.)
2 http://www.immunize.org/askexperts/experts_mmr.asp
3 Watson JC, Hadler SC, Dykewicz CA, Reef S, Phillips L., Measles, Mumps, And Rubella--Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1998 May 22;47(RR-8):1-57
4 http://www.immunize.org/askexperts/experts_mmr.asp

 
Copyright 2012 - American College of Allergy, Asthma & Immunology | 85 West Algonquin Road, Suite 550 | Arlington Heights, IL 60005











website designed and maintained by Washington Graphic Services