Spectrum of IgG2 subclass deficiency in children with recurrent infections: prospective study

Serum immunoglobulins and IgG subclasses were measured in 30 children with recurrent infections. Seven patients had low IgG2 concentrations (less than 3SD below the geometric mean for age). Four of these seven patients had normal concentrations of IgG, IgA and IgM, and thus would have been considered immunologically normal by routine criteria. The seven children with IgG2 deficiency had more severe infections than the 23 children with normal IgG2. Five children had recurrent pneumonia or sinusitis, one had recurrent invasive Haemophilus influenzae type b infections, and one had severe pneumococcal meningitis. Their immunologic abnormalities were heterogeneous. Two children had isolated IgG2 deficiency, two had IgG2-IgG4 deficiency, one had IgG2-IgG4-IgA deficiency, one had IgG2-IgA deficiency, and one had severe IgG1-IgG2 deficiency with abnormal T cell function and thrombocytopenia. Thus IgG2 deficiency occurs frequently among children with recurrent infections, and is associated with a variety of clinical and immunologic abnormalities.