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X-Linked Agammaglobulinemia

(Bruton Disease)


James Fernandez

, MD, PhD, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University

Last full review/revision Apr 2021| Content last modified Apr 2021
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X-linked agammaglobulinemia is a hereditary immunodeficiency disorder due to a mutation in a gene on the X (sex) chromosome. The disorder results in no B cells (a type of lymphocyte) and very low levels of or no antibodies (immunoglobulins).

Symptoms of X-Linked Agammaglobulinemia

For about the first 6 months after birth, immunoglobulins from the mother protect against infection. At about age 6 months, levels of these immunoglobulins start to decrease, and affected infants start having recurring cough, nasal infections (rhinitis), and/or infections of the ears, skin, sinuses, and lungs. The infections are usually due to bacteria such as pneumococci, streptococci, and Haemophilus bacteria. Some unusual viral infections of the brain may develop. The tonsils are very small, and lymph nodes do not develop.

With early diagnosis and treatment, life span is often unaffected, unless brain infections develop.

Diagnosis of X-Linked Agammaglobulinemia

  • Blood tests

  • Sometimes genetic testing

Blood tests are done to measure immunoglobulin levels and the number of B cells.

Genetic testing may be done to confirm the diagnosis of X-linked agammaglobulinemia but is not usually needed. Testing is recommended for close relatives.

Treatment of X-Linked Agammaglobulinemia

  • Immune globulin

  • Antibiotics

Immune globulin (antibodies obtained from the blood of people with a normal immune system) is given throughout life to provide the missing antibodies and thus help prevent infections. Immune globulin may be injected into a vein (intravenously) or under the skin (subcutaneously).

Antibiotics are promptly given to treat bacterial infections and may be given continuously.

People with X-linked agammaglobulinemia are not given vaccines that contain live but weakened organisms (viruses or bacteria). These vaccines include rotavirus vaccines, measles-mumps-rubella vaccine, chickenpox (varicella) vaccine, one type of varicella-zoster (shingles) vaccine, bacille Calmette-Guérin (BCG) vaccine, and influenza vaccine given as a nasal spray.

Despite these measures, chronic sinus and lung infections often develop.

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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