Letters
Immune system diseases Respiratory disease
Volume 194 - Issue 4

Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand

Author:  Anne B Chang

Med J Aust 2011; 194 (4): 213. || doi: 10.5694/j.1326-5377.2011.tb03790.x
Published online: 21 February 2011
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In reply: We thank Gillis and Riminton for their comments highlighting the inclusion of IgG subclasses in the list of suggested investigations when reviewing a patient with chronic suppurative lung disease or bronchiectasis.

We agree that a finding of one or more low IgG subclasses in isolation is not an indication for immunoglobulin therapy and that interpretation of serum IgG subclass concentrations is difficult. Indeed, this was debated at length by the position statement authors. However, after considerable discussion, we decided that measurement of IgG subclasses should be included. Although the data are weak, it is an important area of possible aetiology, and there are varying opinions regarding associations with impaired adaptive immunity.1-3 As with some other investigations, an abnormal test result in the context of a child or adult with suppurative lung disease would lead to discussion with an appropriate subspecialist for advice on interpretation and/or further evaluation.

Space limitations in the Journal version of our position statement did not permit us to elaborate further.4 In the full document available online,5 we stated that:

The benefits of performing IgG subclasses in isolation are particularly controversial as the role of a reduction of a subclass is likely over-diagnosed.[88-91] If IgG subclass is low, assessment of response to vaccinations is advocated.

Author

  • Anne B Chang1,2
  • 1. Royal Children’s Hospital and Queensland Children’s Medical Research Institute, University of Queensland, Brisbane, QLD.
  • 2. Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT.

Correspondence: annechang@ausdoctors.net

Competing interests

See original article for authors’ competing interests.4

References

View this article on Wiley Online Library

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