Immune globulin replacement therapy (IGRT) is indicated for the treatment of primary antibody deficiency (PAD). When clear indications of PAD cannot be established, the need for IGRT can be challenging to determine.
A survey administered by Edgar in the UK, was adapted to investigate the prescribing patterns of US allergists/immunologists when strict diagnostic criteria for CVID, XLA, and other well-defined PIDs were not fulfilled. A/I’s were asked to rank the importance of factors used in decision making to commence IGRT as well as IGRT dosing.
203 Immunologists completed the survey. Clinical assessment of immune deficiency was the most important factor in IGRT. Although 92% of A/I assessed antibody response to vaccine challenge, they relied upon this only to support clinical assessment. 31% assessed high resolution CT scan to rule out the presence of Bronchiectasis (BE). When BE was present, A/Is were 2.4 times more likely to prescribe prophylactic antibiotics and significantly higher starting doses of IGRT.
There is a wide diversity in the approach of allergists/immunologists in the US in determining the need for IGRT for immune deficiency. Although the presence of BE conveys worse prognosis, diagnostic testing for BE in atypical ID was underutilized. When assessed, the presence of BE impacted therapeutic decision making.