Q: I have been diagnosed with common variable immunodeficiency and have started Gamastan S/D intramuscular injections to help build my immune system back up.
I get sinus infections every three months and my doctor says these injections will help not get infections as often, nor will they be as bad, and I will recover faster. Up until now it has taken a month to get over an infection and then another two weeks to get my energy back.
What can you tell me about common variable immunodeficiency and the medication I am on?
A: According to the United States National Library of Medicine, CVID is believed to affect approximately one in every 25,000 to one in every 50,000 individuals worldwide. It appears to affect men and women equally and appears to be less prevalent in Asians and African Americans. It is estimated that almost 25% of individuals with the disorder suffer from an autoimmune disorder that occurs when the immune system inadvertently attacks the blood system, bodily tissues and organs. Genetic mutations may be identified as the cause of the disease in approximately 10% of all reported cases; however, most cases occur in those with no apparent history of the disorder in their family. In some cases, CVID is inherited in an autosomal recessive pattern, implying both copies of a gene in each cell have mutations. Each parent of the individual carries one copy of the mutated gene, yet they may not exhibit any signs or symptoms of CVID. In rare instances, the condition is inherited in an autosomal dominant pattern, meaning one copy of an altered gene in each cell is sufficient to cause the disorder.
Simply put, the disorder impairs a person’s immune system, making individuals with CVID at an increased risk for infection from bacteria and viruses. Those infections that most frequently cause the disorder are hemophilus influenza, staph and strep. The disorder commonly affects the respiratory tract – the nose, sinuses, bronchi, lungs – and the ears; however, the gastrointestinal tract, eyes and skin can also be involved. The infections that cause CVID respond well to antibiotics, however they can recur once the medication is discontinued. To further complicate the issue, such complications as psoriasis, vitiligo, rheumatoid arthritis, primary hypothyroidism, pernicious and hemolytic anemia, non-Hodgkin’s lymphoma, splenomegaly, and more may develop.
According to the European Society for Immunodeficiencies (EDIS) and the Pan American Group for Immunodeficiency (PAGID), a diagnosis of CVID is likely if the onset of the disease is greater than two years, if the patient has a documented decrease of IgG as well as a marked decrease in at least one of the isotypes IgM or IgA in the blood, and if isohemagglutinins are either absent or responses to vaccines in general are less than optimal.
Treatment, as you have discovered, may be in the form of intravenous immunoglobulins into a vein usually in the arms or hands every three to four weeks. Reactions may include fever, hives, chills, muscle aches and pains, fatigue, and more.
The Gamastan S/D intramuscular injections you are on is one of many products that supply the immunoglobulins a patient with CVID is lacking. They help prevent infection in individuals known to have a weakened immune system, or to those individuals exposed to measles, chickenpox, hepatis A, and more. There are pros and cons of each product and the decision whether it is best to take the medication as an intramuscular, subcutaneous or intravenous injection should be discussed. If you have any questions at all as to whether this IM drug is right for you, be sure to address the issues with your prescribing physician.
