CONICET | Buscador de Institutos y Recursos Humanos

Symptomatic hypogammaglobulinemia in children younger than 2 years of age was studied to rule out a primary immunodeficiency. Thirty four patients were referred to the Immunology Service to study the hypogammaglobulinemia-associated clinical picture. Food allergy was documented in 10 patients by personal and familial history, presence of specific IgE and elevated total serum IgE levels. Celiac disease and HIV were also ruled out. Protein loss by stools was assessed by clearance of alfa 1 anti-trypsin (AAT). Serum immunoglobulin levels were determined by nephelometry and functional antibodies were studied by ELISA. The cellular immune response was assessed by in vitro lymphocyte proliferation in response to mitogens and cell subsets were analyzed by flow cytometry. In five patients (5/10) we suspected a protein loss through the mucosa. Four out of five patients showed an increased AAT and the other (1/5) showed and extensive cutaneous lesion. Immunological studies revealed normal antibody function, in vitro lymphoproliferative responses and cell numbers in 4 out of the 5 patients. One patient showed abnormally low numbers of CD4+ T cells as well as a defective proliferative response to mitogens. After diagnosis of cow milk allergy, milk was replaced with infant milk formula containing hydrolyzed proteins. Recovery of immunoglobulin values and clinical resolution was achieved. Hypogammaglobulinemia during the early childhood in some children may be secondary to cow milk allergy (CMA), and immunoglobulins and cells may leak through the inflamed mucosa. Resolution of symptoms as well as normalization of immunoglobulin values may be easily achieved by avoidance of the offending allergen.