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Could Recurrent Infections Be a Sign of Primary Immunodeficiency?

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By Editorial Team

3 min read

Another sinus infection. Another round of antibiotics. Another sick day. You may have been told it is bad luck, weak lungs, or allergies.

Constant infections are exhausting. You finish one prescription, then start another. Work, school, and plans get put on hold.

What recurrent infections may indicate

For some people, recurrent infections are a sign of primary immunodeficiency (PI).1,2

People with PI often see many kinds of doctors before anyone connects the dots. Common variable immunodeficiency (CVID) is the most common type found in adults. Most people with CVID are diagnosed between the ages of 20 and 45. Many have had several doctor visits and hospital stays by then.1,3

What is primary immunodeficiency?

Your immune system protects you from germs. In PI, part of it is missing or does not work correctly. There are hundreds of types, most of which are present at birth. But many are not found until later in life. Some types look like allergies, asthma, or eczema. This overlap can delay a diagnosis.1,2

Severe, persistent, unusual, or recurrent infections

People with PI get common infections, like ear infections, sinus infections, and pneumonia. But theirs happen more often than in other people and tend to be more severe.2

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Watch for infections that are:1,4

  • Severe – They often need IV (into the vein) antibiotics or a hospital stay.
  • Persistent – They do not clear up with standard treatment.
  • Unusual – They are caused by germs that rarely make healthy people sick.
  • Recurrent – They keep coming back, often in the sinuses or lungs.

Warning signs to watch for

Allergy and immunology experts list infection patterns that may signal PI in adults and children. If any of these sound familiar, ask about seeing an allergist/immunologist. Some signs to watch for include:2

  • Needing frequent antibiotics – More than 2 courses a year for adults, or more than 4 a year for children.
  • Frequent ear infections – More than 4 new ear infections in 1 year, after age 4.
  • Frequent sinus infections – More than 3 bacterial sinus infections in 1 year, or sinus infections that never go away.
  • Pneumonia – Pneumonia twice, at any time in your life.
  • Preventive antibiotics – Needing antibiotics just to keep infections from coming back.
  • Unusually severe infections – Common bacterial infections that become much more severe than expected.

How early diagnosis can protect your lungs

Repeated lung infections can lead to bronchiectasis. The airways become damaged, widened, and scarred. There is no cure for bronchiectasis.5

A large review looked at more than 8,500 people with CVID. More than 1 in 4 already had bronchiectasis when they were diagnosed.3

A delayed diagnosis can lead to more severe infections and serious health problems.1

Keep an infection log

An infection log helps your doctor see the whole pattern of continued illness. Doctors will ask how often and how badly you get sick. They will ask how antibiotics treatment worked. They will also ask about family history and vaccines you’ve received.1

Try writing down:

  • Dates and types – When each infection started, where it was in the body, and who diagnosed it.
  • Treatment – Including each antibiotic you took and whether it helped.
  • Care visits – Urgent care, emergency room visits, and hospital stays, including IV antibiotics.
  • Time missed – Days away from work or school.
  • Health history – Your vaccines and any relatives with frequent infections or immune conditions.

Ask for an immunology referral and blood tests

Bring your log to your doctor. Ask if your infections could point to an immune problem. You can also ask for a referral to an allergist/immunologist.2

Blood tests often include a complete blood count and immunoglobulin (antibody) levels. The test checks 3 main types:1,6

  • IgG – The most common antibody. It remembers germs your body has “met” before.
  • IgA – Protects your airways and digestive system.
  • IgM – The first antibody your body makes against a new germ.

Testing is often done 4 to 6 weeks after an infection clears. That is because infections can briefly change results. Your doctor may also check how well you respond to vaccines. Normal first results do not always rule out PI.1,4

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