General: Many patients outgrow their deficiency once they reach adulthood. For those patients who experience persistent deficiencies, antibiotics, gammaglobulin replacement therapy and immunizations may help prevent serious infections and the development of impaired lung function, hearing loss or other injuries caused by infections.
Antibiotics: Antibiotics are used to treat bacterial infections that are commonly associated with IgG subclass deficiency. Different antibiotics will be prescribed for different lengths of time, depending on the type and severity of the infection.
Gammaglobulin therapy: Gammaglobulin prophylaxis (preventative treatment) has been shown in some studies to reduce the number of infections and courses of antibiotics in patients who have substantial IgG subclass deficiencies. Dosages range from 200 to 400mg/kg, given once every three or four weeks.
It is recommended that trough immunoglobulin levels be monitored regularly to help define the optimal time between doses since immunoglobulin clearance varies among individuals. Patients should maintain trough levels at 400-500mg/dL during therapy.
Although the benefits of gammaglobulin therapy are significant, some patients may experience side effects. About 3-12% of patients who receive gammaglobulin therapy develop headache, myalgia (muscle pain), chills, fever and mild nausea upon infusion. If symptoms are intolerable, the infusion rate may be decreased to 0.01mL/kg/min to reduce side effects. In addition, side effects can also be minimized with antihistamines, acetaminophen and/or hydrocortisone.
Immunizations: Vaccination is recommended in patients who do not have antibodies to Pneumococcus and Haemophilus polysaccharides, regardless of whether they have a IgG2 subclass deficiency. If the patient does not respond to Pneumococcus and Haemophilus polysaccharide vaccines, they may be revaccinated with protein-conjugated Pneumococcus and Haemophilus polysaccharide vaccines.
Zinc: Zinc appears to be an essential trace element for the immune system, but research on the effect of zinc supplementation on immune function is scant and mostly focuses on patients with specific diseases. Zinc gluconate appears to exert beneficial effects on immune cells, improving CD3 and CD4 counts and increasing CD4/CD8 ratios in children. There are relatively few studies that examine zinc levels and the effects of zinc supplementation on the health of the elderly population. Further research is needed before a recommendation can be made.
Zinc is regarded as a relatively safe and generally well-tolerated therapy, when taken at recommended doses, and few studies report side effects. The recommended daily dose for adult and teenage males is 15mg. The recommended daily dose for adult and teenage females is 12mg. The recommended daily dose for pregnant females is 15mg and 16-19mg for breastfeeding females. The recommended daily dose for children ages 4-10 is 10mg, and 5-10mg for children 0-3 years old.
Arginine: Preliminary study results suggest that arginine supplementation may enhance the immune response elicited by the pneumococcal vaccine in older people. More studies are needed to confirm these results.
Astragalus: Astragalus has been suggested as an immune system stimulant in preliminary laboratory and animal research, and in traditional accounts. Reliable human studies are lacking. High-quality human research is necessary before a firm conclusion can be drawn.
Beta-carotene: Preliminary research of beta-carotene for immune system maintenance or stimulation shows mixed results. Further research is needed before a conclusion can be drawn.
Cat's claw: A few early studies suggest that cat's claw may boost the immune system. However, results from different studies are conflicting. Therefore, there is not enough information to recommend cat's claw for this use.
Copper: Copper is involved in the development of immune cells and immune function in the body. Severe copper deficiency appears to have adverse effects on immune function, although the exact mechanism is not clear.
Echinacea: Echinacea has been studied alone and in combination preparations for immune system stimulation. It remains unclear if there are clinically significant benefits. Additional studies are needed in this area before conclusions can be drawn regarding safety or effectiveness.
Gamma linolenic acid (GLA): Few clinical trials have investigated the effect of GLA on immune responses in healthy human subjects. Results from one randomized, clinical trial suggest that GLA, as blackcurrant seed oil may offer some benefits. Further, well-designed clinical trials are required before definite conclusions can be made.
Ginseng: A small number of studies report that ginseng may stimulate activity of immune cells in the body, improve the effectiveness of antibiotics in people with acute bronchitis and enhance the body's response to influenza vaccines. Additional studies are necessary before a clear conclusion can be reached.
Goldenseal: Goldenseal has been suggested to be an immune system stimulant. However, there is little human or laboratory evidence in this area. More research is needed before a firm conclusion can be drawn.
Maitake mushroom: Animal and laboratory studies suggest that beta-glucan extracts from maitake may alter the immune system. However, no reliable studies in humans are available.
Massage: Preliminary evidence suggests massage therapy may preserve immune function. Further research is needed before a firm conclusion can be made.
Meditation: Preliminary research reports increased antibody response after meditation. Further study is needed to confirm these findings.
Mistletoe: A few small trials found mistletoe to be promising as an immunostimulant in individuals with the common cold. Further studies are needed to confirm these results.
Probiotics: Lactobacillus in fermented milk, low-fat milk or lactose-hydrolyzed low-fat milk may enhance immune function. Bifidobacterium may also enhance immune function. However, commercially produced yogurt may not yield similar benefits. There is some evidence that probiotics added during food preparation (e.g., waffles with Enterococcus faecium M-74 added) can enhance immune functioning. More studies are needed, particularly with yogurt, to give concrete recommendations.
Vitamin A (retinal): Vitamin A deficiency may compromise immunity, but there is no clear evidence that additional vitamin A supplementation is beneficial for immune function in patients who are not vitamin A deficient.
Vitamin B6 (pyridoxine): Vitamin B6 is important for immune system function in older individuals. One study found that the amount of vitamin B6 required to reverse immune system impairments in elderly people was more than the current recommended dietary allowance (RDA). Well-designed clinical trials on vitamin B6 supplementation for this indication are needed before a recommendation can be made.
Vitamin E: Studies of the effects of vitamin E supplementation on immune system function have yielded mixed results. Further research is needed before a clear conclusion can be drawn.
DHEA (dehydroepiandrosterone): Some textbooks and review articles have suggested that DHEA can stimulate the immune system. However, current scientific evidence does not support this claim.
Lycopene: It has been proposed that lycopene and other carotenoids, such as beta-carotene, may stimulate the immune system. However, several studies of lycopene supplements and tomato juice intake in humans report no effects on the immune system.
Currently, there is no known method of prevention for IgG subclass deficiency.