I have been a pediatrician/family physician for about 40years, and I have been exposed to most diseases.
I have been a pediatrician/family physician for about 40years, and I have been exposed to most diseases. As a child,I had all the standard childhood diseases, including chickenpox,measles, mumps, and rubella. I do not have allergiesand I have never had any serious illness--not even pneumoniaor influenza. However, I have 2 to 4 very severe coldsper year that last as long as 6 weeks (although during theircourse I never have a fever). I usually treat these colds withan antibiotic; however, this does not seem to affect theircourse.
It seems abnormal that a man who has had the exposureI have had should get sick so frequently, so severely,and for so long. Chest and sinus radiographs are usuallynormal, as are immunoglobulin levels and results of completeblood cell counts. Might I suffer from IgA deficiency atthe respiratory-mucosal level? Is there a way to confirm sucha diagnosis?
---- Percy Kepfer, MD
Fort Pierce, Fla
The respiratory symptoms you describe have severalpossible causes. Recurrent sinusitis, particularlyif purulent secretions are present, is a likelypossibility. A thorough ears-nose-and-throat examination--performed when you have symptoms--and an accompanying sinus CT scan can confirm the diagnosis.If sinusitis is present, a longer course of antibiotictherapy might be helpful.Recurrent allergic rhinitis/sinusitis is a secondaryconsideration; to confirm this diagnosis, screening allergytests might be useful. Immune deficiency is highly unlikelyin view of the normal sinus radiograph.The normal serum immunoglobulin determinationsrule out an IgA deficiency. A specific secretory IgA antibodydeficiency would be most unusual. This antibodymay be an important immune parameter, but detectionrequires a specialized research laboratory. Moreover,there is no easy way to confirm this specific deficiency,its clinical significance is only speculative, and there is notreatment for it.
---- Robert E. Reisman, MD
Clinical Professor of Medicine and Pediatrics
State University of New York