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. 2025 Jul-Aug;101(4):569-575.
doi: 10.1016/j.jped.2025.03.002. Epub 2025 Apr 11.

Understanding the natural history of selective IgA deficiency

Nayara Maria Furquim Nasser  1 , Antonio Carlos Pastorino  2 , Thais Costa Lima de Moura  2 , Beni Morgenstern  2 , Mayra de Barros Dorna  2 , Ana Paula Beltran Moschione Castro  2
Affiliations

Understanding the natural history of selective IgA deficiency

Nayara Maria Furquim Nasser et al. J Pediatr (Rio J). 2025 Jul-Aug.

Abstract

Objective: Patients with selective IgA deficiency (SIgAD) present elevated morbidity associated with infections, allergic conditions, autoimmune disorders, and neoplasms. This study aims to characterize clinical manifestations, disease progression, and laboratory findings in a cohort of pediatric patients with SIgAD.

Methods: The study included patients with confirmed SIgAD and a clinical history of at least 5 years. Data encompassed clinical manifestations of the disease, patient outcomes, and laboratory findings, including IgA, IgG, IgM, IgE levels and complete blood count.

Results: A total of 51 patients (1.2:1 female-to-male ratio) were included, with a median age at diagnosis of 6 years. Infections were the most common clinical manifestations of SIgAD (98 %), with pneumonia being the most frequent (94 %), followed by sinusitis (70 %). Additionally, 47 patients (92.1 %) exhibited allergic manifestations, including rhinitis or asthma. Autoimmune conditions were identified in 10 patients, predominantly thyroiditis (60 %), while neoplasms were observed in 3 patients. The sequence of disease onset revealed a natural progression, beginning with infectious diseases, followed significantly by allergic and autoimmune conditions. Elevated immunoglobulin levels (IgM or IgG) were observed in 25 patients, with hypergammaglobulinemia significantly associated with autoimmune conditions or the presence of autoantibodies (p < 0.05).

Conclusions: SIgAD is a clinically significant condition. Understanding its natural history deepens our knowledge of the disease and helps early detection and diagnosis of comorbidities that may arise at various stages of a patient's life. Monitoring other immunoglobulin levels may offer potential biomarkers for predicting autoimmune conditions; however, larger studies are needed to validate these biomarkers.

Keywords: Allergic manifestations; Antibody deficiency; Pediatrics; Recurrent respiratory infections; Selective IgA deficiency.

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Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Screening design. Flowchart of patient selection.
Figure 2
Figure 2
Overlapping disease and follow up. (A) Venn diagram of overlapping disease in patients with SIgAD. (B) Age-dependent disease variation in patients with IgA deficiency.
Figure 3
Figure 3
Immunoglobulins levels: correlations between hypergammaglobulinemia and clinical features in SIgAD patients (A and B).
See this image and copyright information in PMC

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