Dr Spur's mystery case : new symptoms in a patient with selective IgA deficiency

Abstract

A seven-year-old Caucasian girl known to my practice was diagnosed with selective IgA deficiency (sIgAD) two years ago, after recurrent episodes of sinopulmonary infections. Her serum IgA level at the time was <0.07 g/L, with normal IgG and IgM levels and normal vaccine antibody responses. Other causes of IgA deficiency were excluded. She has been doing well on seasonal prophylactic antibiotics and remained infection-free for a year. However, over the past few months her mother noticed frequent episodes of sneezing and a persistent nasal discharge. One month ago she presented to me with an episode of sinusitis which did not respond to conservative management and required antibiotic therapy. At today's follow-up visit she appeared in good general health. She had normal vital signs and a temperature of 36.3 °C. On examination, her nasal turbinates were pale and oedematous, and clear rhinorrhoea was noted. On further enquiry, her mother says that she wakes up with a runny nose and her symptoms are definitely worse in the mornings. She also complains of an itchy nose. Her history and clinical features are highly suggestive of allergic disease. Do you perhaps have experience with sIgAD patients that present with features of atopy? If so, please could you provide further guidance?