Recurrent ENT or respiratory infections in adults: suspected immunodeficiency
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
First-line tests in the community
Laboratory tests
- FBC with differential count (interpret in absolute values)
- Serum immunoglobulins (IgG, IgA, IgM)
- Serum protein electrophoresis (immunofixation if abnormal, so as not to miss a monoclonal peak)
- Tetanus serology (anti-tetanus antibodies)
- HIV serology
- Complement: C3, C4, CH50 (if personal or family history of meningococcal meningitis)if neededThe PNDS provides for complement testing as a first-line test only if there is a personal or family history of meningococcal meningitis; these tests are then available and reimbursed in community laboratories in France [1].
- Total IgEif needednon-French guidelineBronchiectasis: the British BTS requests total IgE and testing for sensitisation to Aspergillus fumigatus in all these patients, to look for allergic bronchopulmonary aspergillosis (grade D) [2]. The PNDS, devoted to immunodeficiencies, does not provide for this assessment [1]. The French laboratory fee schedule (NABM) limits total IgE to a few indications, including bronchopulmonary aspergillosis, and does not allow codes 1200 and 1204 to be billed together [3].
- Specific IgE to Aspergillus fumigatusif needednon-French guidelineBronchiectasis: the British BTS requests total IgE and testing for sensitisation to Aspergillus fumigatus in all these patients, to look for allergic bronchopulmonary aspergillosis (grade D) [2]. The PNDS, devoted to immunodeficiencies, does not provide for this assessment [1]. The French laboratory fee schedule (NABM) limits total IgE to a few indications, including bronchopulmonary aspergillosis, and does not allow codes 1200 and 1204 to be billed together [3].
Urine tests
- Urine dipstick (proteinuria: protein loss through nephrotic syndrome)
Also consider
- Hypogammaglobulinaemia found? If the electrophoresis shows hypogammaglobulinaemia, see the page "Hypogammaglobulinémie de l'adulte".
- Lymphopenia? For lymphopenia, see the page "Lymphopénie".
Do not order
- IgG subclasses as a first-line test: no; they are indicated only for recurrent infections despite a normal IgG level [1].
- “Global” anti-pneumococcal serology in the community: very limited value; the pneumococcal vaccine response is analysed in a specialist setting, by serotype [1].
- Multiplying vaccine serologies: tetanus, Haemophilus and pneumococcus suffice to assess the humoral response, and only tetanus serology is reimbursed in community laboratories in France [1].
Low tetanus serology or old vaccination: check after a booster
- Diphtheria-tetanus-poliomyelitis (± pertussis) booster if the last booster was more than 2 years ago or if the serology is low.
4 to 6 weeks after the booster
- Tetanus serology (check of the vaccine response)
Sources (8)
- Haute Autorité de santé, Centre de référence des déficits immunitaires héréditaires (CEREDIH). Protocole national de diagnostic et de soins (PNDS) : Déficits immunitaires héréditaires (adultes et enfants). Décembre 2022, mis en ligne en avril 2023.
- Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. BMJ Open Respir Res. 2018;5(1):e000348 (version abrégée de Thorax 2019;74 Suppl 1:1-69).
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1200 et 1204 (IgE totales, IgE spécifiques).
- Haute Autorité de santé, CEREDIH. Synthèse à destination du médecin traitant extraite du PNDS Déficits immunitaires héréditaires. Avril 2023.
- Australasian Society of Clinical Immunology and Allergy (ASCIA). Primary Immunodeficiencies (PID) Clinical Update. 2025.
- International Patient Organisation for Primary Immunodeficiencies (IPOPI). Primary immunodeficiencies: a guide for general practitioners. 1re édition, 2016.
- American Academy of Allergy, Asthma & Immunology. Choosing Wisely : Replacement immunoglobulin therapy for recurrent infections. Publié le 4 avril 2012.
- Bonilla FA, Barlan I, Chapel H, et al. International Consensus Document (ICON): Common Variable Immunodeficiency Disorders. J Allergy Clin Immunol Pract. 2016;4(1):38-59.