Increased IgG value

Question

Dear expert team!
I would like to hear your judgement probably also your advice concerning the following situation:
Immunoglobulin G value actually 2100!!
Actual colonization with germs: achromobacter (2 different strains), Staphylococci. Highly allergic 17-year-old girl, also again and again Aspergillus in the sputum (is at the moment treated with itraconazole).
Is there, according to your opinon, a chance to lower the IgG value also with oral antibiotic therapies or is only an i.v. antibiotic therapy helpful respectively more sensible with such a high value?
I am aware, that the Aspergillus is more reflected via the IgE value, however can that rather chronic colonization not also influence somehow the IgG value?
This values hints at a chronic inflammation, doesn't it?
What can one do in order to control this value partly?
Many thanks for your appreciated answer,
D.

Answer

Hello,
Immunoglobulin G (IgG) is the predominant immunoglobulin in the serum and is differentiated into 4 subclasses. IgG are antibodies, that react predominantly against viruses and bacteria. We see an increased IgG in case of chronic infections, chronic acitve hepatitis, auto-immune diseases, IgG plasmozytoma. In case of CF it deals in general with an increased IgG value in the frame of the chronic infection. This value is therefore a marker for infection processes, that are going along in general with inflammation of the airways. An optimal anti-inflammatory therapy, among this also antibiotics (inhalative, as well as orally and/or also intra-venoulsy) suppresses the inflammation. A marker for this can be the decrease of a former increased IgG value. In case of IgG, it deals not with an acute parameter, therefore changes can not be expected in the short runs. Which therapeutic measures are optimal for you, can not be answered via the internet. For this the physician has to know his patient with all results and the course of the illness. In case of planning the therapy, one does never take into account a single parameter ("no laboratory cosmectis" is done), but however the overall picture of all results and the clinical status of the patient leads to a decision concerning the therapy. Therefore it cannot be answered sweepingly if in your case an i.v. antibiotic therapy (and against which germs?) or an anti-fungal therapy should be in the foreground.
An increased IgE value together with the Aspergillus fungus is part of an allergic reaction (e.g. like in case of an allergic broncho-pulmonary aspergillosis ABPA).
The IgG value, like describe above, doesn't have anything to do with allergies, but with germ infections. Fungal infections are in general very severe infections, so that I have not the impression from your mail, that this is the case here. Aspergillus fumigatus in the sputum is rather frequent in CF patients and often "only" as an accompanying germ without effect on the course of the illness. In case of a markedly sensibilisation however, there has to be paid attention to the fungus as a possible allergene.
I hope to have helped you a bit with my information.
Best regards,
Yours
Dr. med. Christina Smaczny

09.10.2015