Despite the critical role of IgA in protecting the human organism from various pathogens, the signs and symptoms in patients suffering from selective IgA immunodeficiency are interestingly absent in up to 90% of cases; the reason for the lack of symptoms is not known [1] [2]. Nevertheless, predisposition toward recurrent infections, autoimmune diseases, and allergies may be present [1] [2] [3] [4] [5] [6]. Infections of the respiratory tract and sinuses (mainly caused by bacterial pathogens such as Haemophilus influenza or Streptococcus pneumoniae) are the most common finding in selective IgA immunodeficiency. More severe forms in which bronchiectasis or other complications occur have also been recognized [1]. The gastrointestinal system, because of its abundant mucosal surface that interacts with numerous pathogens and potentially harmful substances, is another important site where various abnormalities are observed [1] [3]. In addition to infections (bacteria, but also protozoa, an example being Giardia lamblia), malabsorption and lactose intolerance are often encountered in symptomatic patients [1]. Furthermore, gastrointestinal conditions that have been strongly linked to selective IgA immunodeficiency are celiac disease and nodular lymphoid hyperplasia[1]. Allergies and autoimmune disorders are found in a significant number of patients, some of the most common being Graves disease, idiopathic thrombocytopenic purpura (ITP), systemic lupus erythematosus (SLE), and hemolytic anemia [1] [2].

• Plethora

  A plethora of abnormalities in lymphocyte subpopulations and expression of activation markers were repeatedly documented in CVID patients, while almost no data are available about lymphocyte subpopulations in IgAD patients. [ncbi.nlm.nih.gov]

• Recurrent Urinary Tract Infection

  Secretory IgA in recurrent urinary tract infections in childhood. Editorial. Lancet 2:433–434, 1988 Google Scholar 14. Tuttle JP, Sarvas H, Koistinen J: The role of vaginal immunoglobulin A in girls with recurrent urinary tract infections. [doi.org]

• Chronic Productive Cough

  Harrison, Causes of chronic productive cough: An approach to management, Respiratory Medicine, 109, 9, (1105), (2015). [doi.org]

  Pulmonary and sinus disease in primary humoral immunodeficiencies with chronic productive cough. Arch Dis Child. 2003 Dec. 88(12):1101-5. [Medline]. Hermans PE, Diaz-Buxo JA, Stobo JD. Idiopathic late-onset immunoglobulin deficiency. [emedicine.com]

• Diarrhea

  Treatment Ongoing or recurrent infections, allergies, autoimmune diseases, and chronic diarrhea—or a combination of these issues—can lead doctors to suspect selective IgA deficiency. [omicsonline.org]

  For patients with chronic diarrhea repeated courses of antibiotics such as quinolones or metronidazole had been reported. [medcraveonline.com]

  Gastrointestinal infections or chronic diarrhea are also common. [bundoo.com]

  Some other patients with selective IgA deficiency have gastrointestinal infections and ongoing diarrhea. These common infections affect areas with mucosal surfaces that IgA would protect, and may become chronic. [immunedisease.com]

  However, some people who have IgA deficiency experience pneumonia, ear infections, sinus infections, allergies, asthma and diarrhea. [mayoclinic.org]

• Chronic Diarrhea

  Gastrointestinal infections or chronic diarrhea are also common. [bundoo.com]

  For patients with chronic diarrhea repeated courses of antibiotics such as quinolones or metronidazole had been reported. [medcraveonline.com]

  Selective IgA Deficiency Symptoms & Diagnosis The most common symptom of Selective IgA Deficiency is susceptibility to infections including: • Pneumonia • Sinusitis • Ear infections • Chronic diarrhea caused by gastrointestinal infections IgA deficiency [aaaai.org]

  Treatment Ongoing or recurrent infections, allergies, autoimmune diseases, and chronic diarrhea—or a combination of these issues—can lead doctors to suspect selective IgA deficiency. [omicsonline.org]

  Chronic diarrhea. Conjunctivitis. Gastrointestinal inflammation. Mouth infection. 20. Symptoms (2) • • • • • • Otitis media. Pneumonia. Sinusitis. Skin infections. Upper respiratory tract infections. [slideshare.net]

• Oligoarthritis

  Camilleri JP, Moore RH, Griffiths DFR, Williams BD: Selective IgA deficiency associated with glomerulonephritis and oligoarthritis. Ann Rheum Dis 51:123–125, 1992 PubMed Google Scholar 28. [doi.org]

Because of the frequently asymptomatic nature of the disorder, selective IgA immunodeficiency may be difficult to diagnose in a previously healthy individual. But whenever recurrent infections appear, especially with additional gastrointestinal or systemic signs, selective IgA immunodeficiency must be included in the differential [1] [3]. The primary reason is the relatively high prevalence of this condition, with approximately 1 in 400-3000 individuals being affected according to various reports [2]. Thus, the physician should obtain a detailed patient history and conduct a meticulous physical examination during which all important information about the course of symptoms and their progression should be covered. A history of medication use is recommended, as certain drugs may induce low IgA levels [1]. To make a definitive diagnosis, it is necessary to measure levels of immunoglobulins in serum, when the diagnostic criteria are met if levels of IgA are < 0.07 g/L (or < 7 mg/dL) with other serum immunoglobulins being within physiological limits [2] [6]. Further testing of antigliadin and transglutaminase IgG antibodies is mandatory in order to confirm possible celiac disease, as their IgA analogs that are normally identified are absent in these individuals [1].

• Immunoglobulin A Decreased

  Appropriate treatment with immunoglobulin dramatically decreases infection frequency and severity; preventing hospitalization. For most patients, the need for IgG replacement will be lifelong. [clinicaladvisor.com]

• Microcytosis

  Review of the peripheral blood smear revealed mild hypochromia and microcytosis, but was otherwise unremarkable. The mean corpuscular volume was 73 fl (reference, 80–96 fl). The ferritin concentration was 5 ng/mL (reference, 10–150 ng/mL). [jalm.aaccjnls.org]

1. Yel L. Selective IgA Deficiency. J Clin Immunol. 2010;30(1):10-16.
2. Azzi L, Croveri F, Vinci R, et al. Oral manifestations of selective IgA-deficiency: review and case-report. J Biol Regul Homeost Agents. 2017;31(2 Suppl 1):113-117.
3. Hammarström L, Vorechovsky I, Webster D. Selective IgA deficiency (SIgAD) and common variable immunodeficiency (CVID) Clin Exp Immunol. 2000;120:225–231.
4. Geha RS, Notarangelo LD, Casanova JL, et al. Primary immunodeficiency diseases: an update from the International Union of Immunological Societies Primary Immunodeficiency Diseases Classification Committee. J Allergy Clin Immunol. 2007;120:776–794.
5. Abolhassani H, Gharib B, Shahinpour S, et al. Autoimmunity in patients with selective IgA deficiency. J Investig Allergol Clin Immunol. 2015;25(2):112-119.
6. Aghamohammadi A1, Mohammadi J, Parvaneh N, et al. Progression of selective IgA deficiency to common variable immunodeficiency. Int Arch Allergy Immunol. 2008;147(2):87-92.