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Review
. 2017 Nov 8;48(4):314-325.
doi: 10.1093/labmed/lmx058.

The Clinical Utility of Measuring IgG Subclass Immunoglobulins During Immunological Investigation for Suspected Primary Antibody Deficiencies

Antony R Parker  1 , Markus Skold  1 , David B Ramsden  2 , J Gonzalo Ocejo-Vinyals  3 , Marcos López-Hoyos  3 , Stephen Harding  1
Affiliations
Review

The Clinical Utility of Measuring IgG Subclass Immunoglobulins During Immunological Investigation for Suspected Primary Antibody Deficiencies

Antony R Parker et al. Lab Med. .

Abstract

Measurement of IgG subclass concentrations is a standard laboratory test run as part of a panel to investigate the suspicion of antibody deficiency. The assessment is clinically important when total IgG is within the normal age-specific reference range. The measurement is useful for diagnosis of IgG subclass deficiency, to aid the diagnosis of specific antibody deficiency, as a supporting test for the diagnosis of common variable immunodeficiency, as well as for risk stratification of patients with low IgA. The measurement of IgG subclasses may also help determine a revaccination strategy for patients and support patient management. In certain circumstances, the measurement of IgG subclasses may be used to monitor a patient's humoral immune system. In this review, we discuss the utility of measuring IgG subclass concentrations.

Keywords: IgG subclass; common variable immunodeficiency; low IgA; specific antibody deficiency.

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Figures

Figure 1
Figure 1
Algorithm for the measurement of IgGSc in individuals with suspicion of antibody deficiency.
Figure 2
Figure 2
Algorithm for the measurement of IgGSc in individuals with low IgA.
Figure 3
Figure 3
Diagnostic and treatment algorithm for patients with hypogammaglobulinaemia and CVID. Data obtained from Ameratunga et al.
Figure 4
Figure 4
Summary for measuring IgGSc concentrations as a monitoring tool. Normalization of IgGSc may support the diagnosis of THI and exclude suspicion of a more permanent antibody deficiency. The failure of IgGSc concentrations to normalize may be indicative of a more permanent IgGScD or the evolution of a more severe antibody deficiency. The antibody defect may remain IgGScD or develop further into other deficiencies. Examples may include accompanying a progressive deficient response to vaccines developing into clinically relevant IgGScD, development of low IgA alone with IgGScD, or the further development of low IgG or IgA in the progression to CVID.
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