See a Recurrent Infections Specialist in Melbourne, FL

Sinus infections, ear infections, pneumonia, and other upper respiratory infections that are severe, frequent, or long-lasting are considered recurrent infections. Recurrent infections may be a sign of immunodeficiency requiring treatment by an allergist or immunologist. Specific antibody deficiency (SAD) and common variable immune deficiency (CVID) are two disorders that Dr. Beerelli treats.

Overview of SAD

Overview of CVID

Common variable immune deficiency (CVID) is a disorder where the immune system’s B cells are impaired and do not produce enough immunoglobulin, resulting in hypogammaglobulinemia. Because the immune system is defective, patients with CVID often experience recurrent infection. CVID affects both children and adults and it is “variable” because of the many different clinical presentations of the disorder and the fact that it is not just one disease, but a group of diseases resulting from genetic mutation. CVID can be diagnosed in childhood, although it is typically discovered after puberty with most diagnoses occurring between 20 and 40 years of age.

Symptoms of Recurrent Infections

SAD Symptoms

The primary SAD symptoms are recurrent ear, sinus, and/or lung infections. Recurrent infections are:

• 2 or more severe infections in 1 year that involve persistent fever, poor response to oral antibiotics, and hospitalization/ bed confinement for 1 or more weeks.
• 3 or more respiratory (sinusitis, otitis, bronchitis) infections in 1 year.
• Infections that require antibiotics for 2 months/year.

Patients may also present with atopic dermatitis (eczema rash) or asthma.

CVID Symptoms

Most patients with CVID also experience recurrent infections. In fact, only a small percentage of CVID patients (8-10%) have little or no medical history of infection. In addition to recurrent infections, CVID patients may display symptoms related to other conditions. CVID symptoms include:

• Autoimmune disease
• Hematologic disorders
• Severe allergies
• Chronic lung disease
• Gastrointestinal disorders
• Liver disorders

SAD & CVID Diagnosis

To get a SAD or CVID diagnosis, a detailed history and physical exam is conducted. After obtaining a detailed history of your previous infections, symptoms, responses to immunizations and antibiotics, as well as family immunologic history, your allergist/immunologist may order additional laboratory studies to evaluate for SAD or CVID.

Specific tests to diagnose for SAD or CVID may include:

• Serum level measurements of IgG, IgA, and IgM
• IgG subclass level measurements
• Performing a vaccine challenge to assess your immune response to polysaccharide versus protein vaccines

Treatment of Recurrent Infections

All patients with SAD should be immunized with the 13-valent pneumococcal conjugate vaccine or PCV-13 vaccine. Before initiating any therapy for CVID or SAD, patients who have active infection should have their infection treated first. Antibiotics may need to be administered.

SAD Treatment & Management

CVID Treatment & Management

A CVID treatment plan may include immune globulin replacement, which may slow the progression of chronic lung disease and provide some protection against autoimmune disorders, although this is not well studied. Your allergist/immunologist may decide to postpone immune globulin replacement therapy if you have higher levels of serum IgG with only minor impaired response to vaccines. However, you should be continuously monitored every 6 to 12 months.

The safety and efficacy of low dose Interleukin-2 (IL-2) treatment is still under investigation. A small number of allogeneic stem cell transplants have been performed in CVID patients.

Dr. Beerelli is a CVID specialist that can help you look at CVID treatment options.