{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:30:01Z","timestamp":1788388201543,"version":"build-2803163510"},"reference-count":60,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2017,1,30]],"date-time":"2017-01-30T00:00:00Z","timestamp":1485734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5,9]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Primary antibody deficiencies (PAD) constitute the majority of all primary immunodeficiency diseases (PID) and immunoglobulin replacement forms the mainstay of therapy for many patients in this category. Secondary antibody deficiencies (SAD) represent a larger and expanding number of patients resulting from the use of a wide range of immunosuppressive therapies, in particular those targeting B cells, and may also result from renal or gastrointestinal immunoglobulin losses. While there are clear similarities between primary and secondary antibody deficiencies, there are also significant differences. This review describes a practical approach to the clinical, laboratory and radiological assessment of patients with antibody deficiency, focusing on the factors that determine whether or not immunoglobulin replacement should be used. The decision to treat is more straightforward when defined diagnostic criteria for some of the major PADs, such as common variable immunodeficiency disorders (CVID) or X-linked agammaglobulinaemia (XLA), are fulfilled or, indeed, when there is a very low level of immunoglobulin production in association with an increased frequency of severe or recurrent infections in SAD. However, the presentation of many patients is less clear-cut and represents a considerable challenge in terms of the decision whether or not to treat and the best way in which to assess the outcome of therapy. This decision is important, not least to improve individual quality of life and reduce the morbidity and mortality associated with recurrent infections but also to avoid inappropriate exposure to blood products and to ensure that immunoglobulin, a costly and limited resource, is used to maximal benefit.<\/jats:p>","DOI":"10.1111\/cei.12915","type":"journal-article","created":{"date-parts":[[2016,12,21]],"date-time":"2016-12-21T09:03:48Z","timestamp":1482311028000},"page":"333-341","source":"Crossref","is-referenced-by-count":131,"title":["When to initiate immunoglobulin replacement therapy (IGRT) in antibody deficiency: a practical approach"],"prefix":"10.1093","volume":"188","author":[{"given":"S","family":"Jolles","sequence":"first","affiliation":[{"name":"Immunodeficiency Centre for Wales, Department of Immunology, University Hospital of Wales, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Chapel","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Litzman","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Allergology, St Annes's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,1,30]]},"reference":[{"key":"2021120808085200200_cei12915-bib-0001","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1365-2249.2009.03954.x","article-title":"The European internet-based patient and research database for primary immunodeficiencies: results 2006\u20132008","volume":"157","author":"Gathmann","year":"2009","journal-title":"Clin Exp Immunol"},{"key":"2021120808085200200_cei12915-bib-0002","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1007\/s10875-015-0201-1","article-title":"Primary immunodeficiency diseases: an update on the classification from the international union of immunological societies expert committee for primary immunodeficiency 2015","volume":"35","author":"Picard","year":"2015","journal-title":"J Clin Immunol"},{"key":"2021120808085200200_cei12915-bib-0003","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.jaip.2013.09.015","article-title":"The variable in common variable immunodeficiency: a disease of complex phenotypes","volume":"1","author":"Jolles","year":"2013","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2021120808085200200_cei12915-bib-0004","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jaip.2015.07.025","article-title":"International consensus document (ICON): common variable immunodeficiency disorders","volume":"4","author":"Bonilla","year":"2016","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2021120808085200200_cei12915-bib-0005","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1006\/clim.1999.4799","article-title":"Diagnostic criteria for primary immunodeficiencies. 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