Transient Hypoglammaglobulinemia of Infancy
Also see B-cell defects

Problem: Delay in the maturation of B cells and antibody production

• Get transient extension of hypogammaglobulinemia beyond 6 months of age
• Extreme of normal variability of the immune system

Presentation: Recurrent viral and pyogenic infections (OM, URI, sinusitis, rarely pneumonia) between 4-9 months of age

• Infections are not life-threatening
• Respond appropriately to antibiotics

Trend of immunoglobulins in the serum of the fetus and nbn child (mg/dL)

1. Maternal IgG: builds up in fetus to max 1000 mg/dL, then after birth quickly drops to <50 at age 4 mos and gone by 8 mos
2. Infant IgG: rapid, almost vertical rise from zero in first two months of life then gradual increase
3. IgM: gradual rise from third trimester through birth and infancy
4. IgA: gradual rise from birth

Labs:

• Hypogammaglobulinemia
• Able to distinguish from XLA and CVID by:
  • Normal numbers of B and T lymphocytes
  • Presence of antibodies to diphtheria and tetanus toxoids
  • Presence of antibodies to human blood group types (anti-A and anti-B) in THI

Treatment:

• Antibiotics
• IVIG not indicated

Prognosis: Recovers spontaneously by 1-3 yo

CHLA Board review 2005