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December 9, 1983

Possible Immunoglobulin Deficiency

Author Affiliations

Binghamton, NY

JAMA. 1983;250(22):3047. doi:10.1001/jama.1983.03340220019017

To the Editor.—  In the article entitled "Developmental Immunology and the Immunodeficiency Diseases" by Cooper and Buckley (1982;248:2658), the reference to a scarcity of documented cases of ill infants with transient but accentuated physiological γ-globulin deficiency is surprising. Any infant younger than 18 months of age with repeated finger or toe infections, otitis media, diarrhea, or bronchitispneumonia should have a complete differential cell count and quantitative immunoglobulins measured. Other tests might include those for complement levels and neutrophil function,1 if the other measurements are normal. Do not test if the infants are not frequently sick or if other explanations are sufficient.What can one find? In 13 years of active pediatric practice, I have seen 20 cases of hypogammaglobulinemia type IV (low IgG level) (mean value, 200 mg/dL; mean age, 7 months); eight cases of dysgammaglobulinemia type I (low IgG and IgA levels) (mean IgG value, 171 mg/dL; mean