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Immunologic evaluation by a pediatric pulmonologist.

Kasama Manothummetha1, Matthew Wyke1, Gary Kleiner2

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Summary

Pediatric pulmonologists can identify and manage immune dysfunction in children with respiratory issues. This review offers a framework for recognizing inborn errors of immunity (IEI) and acquired immunodeficiencies, improving patient outcomes.

Keywords:
Immunologic evaluationInborn errors of immunityPediatric pulmonologySecondary immunodeficiency

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Area of Science:

  • Pediatric Pulmonology
  • Immunology
  • Genetics

Background:

  • Respiratory symptoms are common in children with inborn errors of immunity (IEI) and acquired immunodeficiencies.
  • Pediatric pulmonologists frequently encounter these patients but underutilize immunologic evaluations due to complexity.
  • Access to timely immunologist consultations can be limited for affected children.

Purpose of the Study:

  • To provide a practical framework for pediatric pulmonologists to identify, evaluate, and manage immune dysfunction in children with respiratory disease.
  • To outline clinical indicators and diagnostic strategies for immune-related respiratory conditions.
  • To review common IEI and acquired immunodeficiencies presenting with respiratory manifestations.

Main Methods:

  • Review of clinical indicators for immune dysfunction in pediatric respiratory patients.
  • Description of the utility and limitations of key immunologic tests.
  • Presentation of stepwise diagnostic strategies, including screening, functional assays, and genetic testing.

Main Results:

  • Identifies key clinical indicators like recurrent infections, bronchiectasis, and failure to thrive.
  • Details common IEI (antibody deficiencies, combined immunodeficiencies, phagocytic disorders, immune dysregulation syndromes) and acquired immunodeficiencies.
  • Addresses diagnostic mimics and principles of pulmonary co-management, prophylaxis, and follow-up.

Conclusions:

  • Early recognition and collaborative care between pulmonologists and immunologists are crucial.
  • Implementing this framework can improve outcomes and prevent irreversible pulmonary damage in children with immune dysfunction.
  • Enhanced understanding and utilization of immunologic evaluations are vital for managing pediatric respiratory conditions.