Hypogammaglobulinemia during infancy and atopic dermatitis

Background: Hypogammaglobulinemia during infancy (HI) is often transient, resolves with time, and typically does not associate with a specific immunologic deficiency. If hypogammaglobulinemia persists, then it may be secondary to an immunologic disorder and be associated with significant clinically diagnosed infections. When phenotyping HI, any implications of associated atopic dermatitis (AD) can be clinically helpful. Objective: The purpose of this study was to explore the clinical and immunologic differences between patients who have HI and AD versus those with AD alone or with HI alone. Methods: We conducted a retrospective record review of patients with AD, HI with AD (HIcAD), and HI only seen in a large academic practice. Patient characteristics, comorbidities, clinical, and laboratory parameters as well as immunoglobulin G (IgG) at the last follow-up were noted. If HI resolved, then the age of resolution was noted. Data were analyzed by using the χ² test, Fisher exact test, Wilcoxon rank sum test, Monte Carlo estimates, and Kaplan-Meier product-limit curves, as appropriate. Results: There was no significant difference in age of presentation, gender at birth, or number or type of clinically diagnosed infections among the groups, but there was a significant difference in the levels of IgG, IgA, IgM, and IgE. More children in the HIcAD group had high IgE levels, significantly higher leukocyte counts, eosinophil counts, T and B cell numbers, and severe AD, and resolved HI in the study period than in the HI-only group. Conclusion: Analysis of our findings suggests that infants with HIcAD are more likely to have severe AD, to resolve hypogammaglobulinemia, and to have immunologic dysregulation without increased clinically diagnosed infections.