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Selective Antibody Deficiency With Normal Immunoglobulins


James Fernandez

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

Medically Reviewed Apr 2021 | Modified Sep 2022

Selective antibody deficiency with normal immunoglobulins is characterized by an inadequate response to certain types of antigens (foreign substances in the body) but not to others, even though people have normal or near normal levels of antibodies (immunoglobulins).

  • People with selective antibody deficiency with normal immunoglobulins have frequent sinus and lung infections.

  • Doctors diagnose the disorder by measuring immunoglobulin levels in the blood and by evaluating how well people respond to vaccines.

  • Treatment includes vaccination with the pneumococcal conjugate vaccine, antibiotics to treat infection and to prevent infections from occurring, and sometimes immune globulin.

Vaccines Active immunization Immunization enables the body to better defend itself against diseases caused by certain bacteria or viruses. Immunity (the ability of the body to defend itself against diseases caused by certain... read more contain antigens from the bacteria or viruses they are intended to protect against. Normally, the body’s immune system responds to a vaccine by producing substances (such as antibodies Antibodies One of the body's lines of defense ( immune system) involves white blood cells (leukocytes) that travel through the bloodstream and into tissues, searching for and attacking microorganisms and... read more Antibodies ) and mobilizing white blood cells that recognize and/or attack the specific bacteria or virus represented in the vaccine. Then whenever people who have been vaccinated are exposed to the specific bacteria or virus, the immune system automatically produces these antibodies and takes other action to prevent or lessen illness. People with selective antibody deficiency do not produce antibodies in response to polysaccharide vaccines.

Affected people have many sinus and lung infections and sometimes symptoms of allergies, such as a chronic runny and stuffy nose (rhinitis), a rash, and asthma. The severity of the disorder varies.

Some children have a form of the disorder that resolves on its own over time.


  • Blood tests to measure immunoglobulin levels and response to vaccines

Children are not tested for this disorder until after age 2 years because young healthy children may have frequent sinus and lung infections and weak responses to certain vaccines.

Testing consists of blood tests to measure levels of immunoglobulins and to evaluate how well the body produces immunoglobulins in response to vaccines. Normal levels of antibodies and an inadequate response to certain vaccines confirms the diagnosis.


  • Vaccination with the pneumococcal conjugate vaccine

  • Antibiotics to treat infections

  • Sometimes immune globulin

As part of their routine childhood vaccinations, children are vaccinated with the pneumococcal conjugate vaccine Administration to prevent pneumococcal infections. Children who have selective antibody deficiency with normal immunoglobulins respond to this vaccine, which differs from the pneumococcal polysaccharide vaccine.

Sinus and lung infections and allergy symptoms are treated. Occasionally, when infections continue to recur after treatment, people are given antibiotics (such as amoxicillin and trimethoprim/sulfamethoxazole) to prevent the infections from recurring.

Rarely, when infections recur frequently despite use of these antibiotics, people are given injections of immune globulin (antibodies obtained from the blood of people with a normal immune system). Immune globulin may be injected into a vein (intravenously) or under the skin (subcutaneously).

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.

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