Selective deficiency of IgA
IgA deficiency; Immunodepressed - IgA deficiency; Immunosuppressed - IgA deficiency; Hypogammaglobulinemia - IgA deficiency; Agammaglobulinemia - IgA deficiency
Selective deficiency of IgA is the most common immune deficiency disorder. People with this disorder have a low or absent level of a blood protein called immunoglobulin A.
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Causes
IgA deficiency is usually inherited, which means it is passed down through families. However, there are also cases of drug-induced IgA deficiency.
It may be inherited as an autosomal dominant or autosomal recessive trait. It is usually found in people of European origin. It is less common in people of other ethnicities.
Symptoms
Many people with selective IgA deficiency have no symptoms.
If a person does have symptoms, they may include frequent episodes of:
- Bronchitis (airway infection)
- Chronic diarrhea
- Conjunctivitis (eye infection)
- Gastrointestinal inflammation, including ulcerative colitis, Crohn disease, and a sprue-like illness
- Mouth infection
- Otitis media (middle ear infection)
- Pneumonia (lung infection)
- Sinusitis (sinus infection)
- Skin infections
- Upper respiratory tract infections
Other symptoms include:
- Bronchiectasis (a disease in which the bronchial tubes in the lungs become damaged and enlarged)
- Asthma without a known cause
Exams and Tests
There may be a family history of IgA deficiency. Tests that may be done include:
- IgG subclass measurements
- Quantitative immunoglobulins
- Serum immunoelectrophoresis
Treatment
No specific treatment is available. Some people gradually develop normal levels of IgA without treatment.
Treatment involves taking steps to reduce the number and severity of infections. Antibiotics are often needed to treat bacterial infections.
Immunoglobulins are given through a vein or by injection to boost the immune system.
Autoimmune disease treatment is based on the specific problem.
Note: People with complete IgA deficiency may develop anti-IgA antibodies if given blood products and immunoglobulins. This may lead to allergies or life-threatening anaphylactic shock. However, they can safely be given IgA-depleted immunoglobulins.
Outlook (Prognosis)
Selective IgA deficiency is less harmful than many other immunodeficiency diseases.
Some people with IgA deficiency will recover on their own and produce IgA in larger quantities over a period of years.
Possible Complications
Autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and celiac sprue may develop.
People with IgA deficiency may develop antibodies to IgA. As a result, they can have severe, even life-threatening reactions to transfusions of blood and blood products.
When to Contact a Medical Professional
If you have an IgA deficiency, be sure to mention it to your health care provider if immunoglobulin or other blood-component transfusions are suggested as a treatment for any condition.
Prevention
Genetic counseling may be of value to prospective parents with a family history of selective IgA deficiency.
References
Cunningham-Rundles C. Primary immunodeficiency diseases. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 236.
Sullivan KE, Buckley RH. Primary defects of antibody production. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 150.
Version Info
Last reviewed on: 1/23/2022
Reviewed by: Stuart I. Henochowicz, MD, FACP, Clinical Professor of Medicine, Division of Allergy, Immunology, and Rheumatology, Georgetown University Medical School, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
