Objective: Asthma is a heterogeneous disease with varying clinical presentations. Hypogammaglobulinemia may increase susceptibility to respiratory tract infections and thereby influence asthma morbidity. Subjects and Methods: We retrospectively analyzed 332 children aged 4–12 years who were followed for asthma at a tertiary pediatric allergy and clinical immunology clinic between 2015 and 2020. Patients were categorized as normogammaglobulinemic (NGG) (n=286) or hypogammaglobulinemic (HGG) (n=46). Hypogammaglobulinemia was defined as persistently low IgG (below -2 SD for age), with or without concomitant low IgA and/or IgM. Results: Children in the HGG group had an earlier onset of asthma symptoms and earlier asthma diagnosis, and lower breastfeeding rates (p<0.001, p=0.001, and p=0.024, respectively). The prevalence of atopic dermatitis and parental atopy was higher, and the annual frequency of upper respiratory tract infections, acute otitis media, lower respiratory tract infections (bronchopneumonia) not requiring hospitalization, and asthma exacerbations were significantly higher in this group (all p<0.005). Inhaled corticosteroid therapy was initiated and discontinued at younger ages among HGG children (p<0.001 and p=0.002, respectively). Atopic sensitization rates did not differ between groups. Conclusion: In this tertiary-care cohort, HGG defined by persistently low IgG was associated with earlier-onset asthma symptoms and a higher infection and exacerbation burden. These findings may support considering immunologic evaluation and closer monitoring in a subset of children with asthma.
Akpinar et al. (Mon,) studied this question.