Recurrent infections a possible sign of immunodeficiency

Recurring infections, especially in children, may be a sign of an underlying immune deficiency rather than just frequent illness, says an expert.

Speaking at the recent ENT Summit 2025, held in Kuala Lumpur, Dr Peter Catalano, Professor of Otolaryngology, noted immunodeficiencies are more common than most healthcare providers realize, potentially affecting up to 20 percent of patients in a practice.

Patients with immunodeficiencies present with recurrent sinusitis, common colds, pneumonia, yeast infections and otitis. Immunodeficiencies can be primary (congenital) or secondary (due to diseases like diabetes, cancer, or medications). “These are the patients that keep returning to the clinic with recurrent infections, yet no one else at home or at work is sick,” Catalano said. “They also take a long time to recover … This should be a red flag.” Specific antibody deficiency (SAD), a type of immunodeficiency, is a common condition that can cause recurrent and persistent infections, particularly in the upper respiratory tract.

To determine if the patient is immunodeficient, blood tests, including white blood cell count, immunoglobulin and pneumococcal antibody assays are necessary for diagnosis.
Physicians should account for confounding factors such as recent steroid use, recent history of surgery, viral infections, age of patient and nutritional status as these can affect the test results.

Once a diagnosis of immunodeficiency is confirmed, the available the primary treatment option is a pneumococcal vaccination.  Here, Catalano reiterated the importance of getting children tested for pneumococcal antibody levels as it can unveil a hidden immunodeficiency. In those who are immunodeficient, the pneumococcal vaccine may prevent or reduce the frequency and severity of illness.

Vaccination against pneumococcal diseases is not an automatic ticket to immunity, and as such, Catalano called for repeat testing of IgG antibodies 3 to 6 months after the shot. If antibody levels continue to be low, then the pneumococcal 23 vaccine should be repeated. If antibody levels remain low, an alternative treatment option should be considered with IVIG (intra-venous immune globulin) which is done by an immunologist. Periodic testing of antibodies will determine if the immunodeficiency is transient or permanent.

While IVIG is considered expensive, the benefits come in the form of long-term reduction in complications and hospitalization. The duration of IVIG treatment is uncertain, and it is usually indicated for patients with significant immunodeficiencies.

Collaboration and communication is key
Catalano also brought up the importance of listening to patients and going beyond standard treatments plus the benefits of working closely with immunologists, as complex cases or those with a permanent immunodeficiency will often need to be referred for additional tests or checks.

Often, SAD can progress to common variable immunodeficiency, which is a complex disease that can lead to autoimmune problems, lung disease, gastrointestinal issues, and even increased cancer risk. Therefore, a close ENT specialist-immunologist working relationship will be beneficial for the patient.