DefinitionAgammaglobulinemia is disorder passed down through families in which a person has very low levels of protective immune system proteins called immunoglobulins. Immunoglobulins are a type of antibody. Low levels of these antibodies make you more likely to get infections.
Alternative NamesBruton's agammaglobulinemia; X-linked agammaglobulinemia
Causes, incidence, and risk factorsAgammaglobulinemia is a rare disorder that mainly affects males. It is caused by a gene defect that blocks the growth of normal, mature immune cells called B lymphocytes.As a result, the body makes very little (if any) immunoglobulins in the bloodstream. Immunoglobulins play a major role in the immune response, which protects against illness and infection.Persons with agammaglobulinemia repeatedly develop infections, especially bacterial infections such as Hemophilus influenzae, pneumococci (Streptococcus pneumoniae), and staphylococci. Common sites of infection include:Gastrointestinal tractJointsLungsSkinUpper respiratory tractAgammaglobulinemia is inherited, which means other people in your family may have the condition.
SymptomsSymptoms include frequent episodes of:BronchitisChronic diarrheaConjunctivitis (eye infection)Otitis media (middle ear infection)PneumoniaSinusitisSkin infectionsUpper respiratory tract infectionsInfections typically appear in the first 4 years of life.Other symptoms include:Bronchiectasis (a disease in which the small air sacs in the lungs become damaged and enlarged)Unexplained asthma
Signs and testsThe disorder is confirmed by laboratory measurement of blood immunoglobulins.Tests include:Flow cytometry to measure circulating B lymphocytesImmunoelectrophoresis - serumQuantitative immunoglobulins - IgG, IgA, IgM (usually measured by nephelometry)
TreatmentTreatment involves taking steps to reduce the number and severity of infections. You will receive immunoglobulins through a vein (IVIG), which boosts your immune system.Antibiotics are often needed to treat bacterial infections.Genetic counseling may be helpful.
Expectations (prognosis)Treatment with IVIG has greatly improved the health of those who have agammaglobulinemia. Without treatment, most severe infections are deadly.
ComplicationsArthritisChronic sinus or pulmonary diseaseEczemaIntestinal malabsorption syndromes
Calling your health care providerCall for an appointment with your health care provider if:You or your child has experienced frequent infectionsYou have a family history of agammaglobulinemia or another immunodeficiency disorder and you are planning to have children (ask the provider about genetic counseling)
PreventionGenetic counseling should be offered to prospective parents with a family history of agammaglobulinemia or other immunodeficiency disorders.
ReferencesBallow M. Primary immunodeficiency diseases. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier;2011:chap 258.Morimoto Y. Immunodeficiency overview. Prim Care. 2008;35(1):159-173.