Investigation of transient hypogammaglobulinemia of infancy in the
etiology of chronic cough in children under five years old
Abstract
Chronic cough is one of the most common complaints of childhood to
consult a doctor. There are many causes such as respiratory tract
infections, gastroesophageal reflux, persistent bacterial bronchitis,
asthma, cystic fibrosis, congenital malformations, and foreign body
aspiration in children under the age of five. However, neither transient
hypogammaglobulinemia of infancy (THI) among the causes of chronic
cough, nor chronic cough among the application complaints of THI are not
questioned. In this study, we aimed to draw attention to the role of THI
in the etiology of chronic cough under the age of five. Our study
included 55 pediatric patients under the age of five who applied to the
pediatric pulmonary diseases outpatient clinic in between January 2015
and December 2020 with the complaint of chronic cough, who were excluded
from other causes of chronic cough in etiology, and who met the criteria
for THI according to the European Society for Immunodeficiencies (ESID).
Demographic, clinical and laboratory characteristics and follow-ups of
these patients were reviewed retrospectively. In our study, the mean age
of 55 patients at admission was 21.73 ± 11.50 months (median age: 18
months), and the mean age of IgG recovery was 38.65 ± 16.81 months. The
mean recovery time was 16.93 ± 12.85 months. Of the patients, 22.4% had
a history of consanguinity, 23.4% had prematurity, and 18.2% had a
frequent sickness in siblings. The most common complaint accompanying
chronic cough in patients was frequent respiratory tract infection,
16.3%. Along with IgG, 26.4% of the patients had low IgA and 31.5%
had low IgM in laboratory testing. In antibody responses,
isohemagglutinin, anti-tetanus, anti-pneumococcal, anti-HBs vaccine
responses were found to be positive in 90.6%, 63.9%, 66.7% and 97.7%
of the cases, respectively. 72.7% of the patients received inhaler
treatment, 45.5% received antibiotic prophylaxis, and 2.2% received
intravenous immunoglobulin (IVIg) treatment. After the IgG value of the
patients returned to normal, it was observed that 86.3% of the
patients’ cough complaint have disappeared. Transient
hypogammaglobulinemia of infancy mostly presents with recurrent lower
and upper respiratory tract infections. The most common complaint is
cough. It is not questioned whether the cough is chronic or not. In this
study, we aimed to investigate the follow-up and prognosis of patients
under the age of five who had a chronic cough complaint, when other
causes of cough were ruled out and THI was detected. In the study, when
the IgG levels of the patients return to normal, the cough complaints
disappear to a large extent, showing that THI may also be among the
causes of chronic cough.