Background When a physician comes across patients with recurrent wheezing are resistant to β2-agonist and anti-cholinergic therapy, known as atypical wheezing cases; he should investigate for hypogammaglobulinemia in these patients.
Aim Here, 3 cases are reported to make paediatricians aware of hypogammaglobulinemia, which is one of the reasons causing recurrent and persistent wheezing attacks during infancy and beyond.
Case presentations Case 1: 24 month-old girl presented to us with complaining of coughing and persistent wheezing. Her symptoms persisted even though she was using religiously nebulized salbutamol+budesonid therapy. Before this episode, she had 9 other wheezing attacks in her past medical history beginning from 2 months of age. Low IgG level (358 mg/dl) was detected at two different times. At the fourth day of admission, she was given IVIG 500mg/kg/dose. Case 2: 8-month-old girl came to our outpatient clinic with complaints of coughing and wheezing. Despite routine therapy, wheezing persisted for 2 months and wheezing severity increased and it did not respond to β2-agonist therapy. Low IgG level (304 mg/dl) was detected at two different times. At the 15th day of admission, she was given IVIG 500mg/kg/dose. Case 3: 20 month-old boy presented with complaints of having frequent lower respiratory tract infections. He was experiencing recurrent wheezing attacks almost every other week for the last 6 months. Low IgG level for his age (300 mg/dl) was detected twice. He was given IVIG 400 mg/kg/dose.
Conclusion In patients with persistent wheezing symptoms during infancy, especially resistant to therapy, hypogammaglobulinemi should be excluded.