Secondary antibody deficiencies

Purpose of review Antibody deficiency can occur in the context of primary immune deficiency due to inherited genetic defects or secondary to a variety of causes. This review aims to summarize current data concerning the causes of secondary antibody deficiency and where possible evidence regarding the use of prophylactic replacement immunoglobulin. Recent findings Advances in immune-mediated therapies ranging from monoclonal antibodies to novel B-cell- targeted therapeutics are responsible for an expansion in the possible iatrogenic causes of antibody deficiency. Summary Causes of secondary antibody deficiency include B- cell lymphoproliferative disease, notably chronic lymphocytic leukaemia and multiple myeloma, protein losing states, disorders of lymphatic circulation, increased immunoglobulin catabolism and a growing number of therapeutic agents. At-risk patients should be closely monitored for the development of hypogammaglobulinaemia, B- cell function should be defined where appropriate with specific antibody responses to immunization antigens and where there is a significant burden of infections patients should be treated with prophylactic antibiotics and/or replacement immunoglobulin.