Abstract
Background: The relationship between hypogammaglobulinemia and wheezing in childhood has been previously revealed. Objectives: The study aimed to investigate co-morbid immune deficiency in unresponsive asthmatic children, characterize the type of immune deficiency, and determine any possible effect of immune deficiency treatment on the applied standard guideline of asthma treatment. Methods: This was a prospective study conducted between January 2012 and December 2014. A total of 286 children whose serum immunoglobulin (Ig) levels had been analyzed were collected. Among those children, 125 (m/f = 79:46, mean +-SD of age = 41.3 + 25.2 months) were enrolled as they had uncontrolled moderate to persistent asthma. Those 125 children were categorized as the only asthma group and the asthma + hypogammaglobulinemia (HGG) group depending on their immunoglobulin concentrations. Results: Seventy-six of the 125 children (60.8%) had co-morbid hypogammaglobulinemia. Atopy was higher in the Asthma + HGG group (P = 0.044). The most frequent co-morbid HGG was transient hypogammaglobulinemia of infancy (THGI) (46.1%) and IgG subclass deficiency (32.9%). Although the comparison of the percentage use of the inhaled corticosteroids (ICSs) showed no significant difference between the two groups at the initial evaluation, the dose of ICS significantly decreased only in the asthma + HGG group (P = 0.017). Conclusions: The majority of asthmatic children having symptoms despite appropriate guideline-based treatment may have a co-morbid immunological abnormality. Presented data demonstrated the necessity of immunological evaluation of uncontrolled asthmatic children to prevent long-term side effects of high-dose ICS, reduce the frequency and severity of asthma symptoms, and improve the quality of life.
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