IgG and IgG4 Abnormalities: Lifelong Medication and Health Implications

IgG: 1750 and IgG4: 208?

Hello Doctor,
I apologize for bothering you, but I have some questions.
Recently, after several days of staying up late, I have been feeling very fatigued, experiencing dry mouth and reduced saliva.
Therefore, I visited an oral surgeon, but they did not conduct a detailed examination and referred me to a rheumatology and immunology specialist to check for symptoms of Sjögren's syndrome.
They indicated that I should rule out dryness symptoms before returning to the oral surgeon for further evaluation.
After blood tests at the rheumatology and immunology department, the doctor said there were no signs of Sjögren's syndrome, but there were indeed some issues with my immune system, such as abnormalities in the fourth subtype.
(I didn’t quite catch all the details.) My IgG level was 1750 and IgG4 was 208.
The doctor mentioned these values were abnormal and prescribed medication, starting with a one-month supply of Plaquenil (200 mg tablet) that I need to take daily, and stated that I would need to "take this medication for life" and have regular follow-up appointments.
1.
Is it true that these test results require me to take medication every day for life? Hearing "you need to take medication for life" is quite frightening! What disease is this? What symptoms or conditions could arise if I do not take the medication?
2.
Could there be other factors causing the abnormalities in my IgG and IgG4 levels? (A.
I had a car accident in mid-July, resulting in a small fracture in the second metatarsal of my left foot and skin injuries on my calf and knee.
Since I did not take proper care of the calf wound, it became red and swollen due to an allergic reaction after using artificial skin for too long around September.
Although the calf wound has healed, the surrounding area still shows signs of edema and peeling.
Could this affect my test results? B.
I drank a bottle of milk before the blood draw; could that also influence the results?)
Additionally, I used to not be allergic to shrimp, but now that I am an adult, I have developed an allergy to shrimp.
Could this also be related to the IgG abnormalities? Thank you for your help.

The abnormal test values are as follows:
IgG: 1750
IgG4: 208
WBC: 17.48
RBC: 5.13
PLT: 425
Other general blood, biochemical, and rheumatology/immunology tests are within normal ranges.

A Xuan, 30~39 year old female. Ask Date: 2017/11/29

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
I will address your questions as follows:
1.
You may have IgG4-related disease, which has symptoms similar to Sjögren's syndrome.
It may require long-term medication, but there might be possibilities for dose reduction or discontinuation.
This should be discussed further with your original physician.
2.
Immunoglobulin G (IgG) is an antibody produced in the body that is related to immunity.
IgG can be divided into four subclasses based on its structure, one of which is IgG4.
Typically, IgG levels increase in response to infections; however, when there are issues with the immune system, IgG levels can also rise.
Your situation may indicate an immune system problem leading to elevated IgG4 levels, resulting in clinical symptoms, particularly Sjögren's syndrome.
Similar to conditions like diabetes and hypertension, immune system disorders often require long-term medication.
However, as one ages, the immune system may also undergo changes, potentially leading to a reduction in symptoms.
Therefore, there may be opportunities for dose adjustments of immunosuppressive medications, which should be coordinated with your physician.
2A.
Early trauma from a car accident will not affect the results of this examination.
2B.
Consuming milk will not impact the results of this examination.
3.
Allergies to shrimp are more closely related to another type of antibody, Immunoglobulin E (IgE), rather than IgG.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2017/11/29

More Info

Understanding the implications of elevated IgG and IgG4 levels can be complex, especially when it comes to long-term treatment and health outcomes. Based on your inquiry, let’s break down the key points regarding IgG and IgG4 abnormalities, potential lifelong medication, and other contributing factors.

1. Lifelong Medication and Health Implications
The elevated levels of IgG (1750 mg/dL) and IgG4 (208 mg/dL) suggest that there may be an underlying immune system disorder. In particular, elevated IgG4 can be associated with IgG4-related disease, which is an autoimmune condition that can affect various organs and lead to symptoms such as dryness, swelling, and pain. The mention of needing to take medication like Plaquenil (hydroxychloroquine) daily, potentially for life, can understandably cause concern.

The necessity for lifelong medication depends on the specific diagnosis and the severity of the condition. In some cases, patients may need to remain on medication indefinitely to manage symptoms and prevent complications. However, it is also possible that over time, with appropriate management and monitoring, the dosage may be adjusted or even discontinued. Regular follow-ups with your rheumatologist or immunologist are crucial to assess the effectiveness of the treatment and make necessary adjustments.

If left untreated, conditions associated with elevated IgG4 can lead to significant health issues, including organ damage and chronic inflammation. Therefore, adhering to the prescribed treatment plan is essential for maintaining health and preventing complications.

2. Factors Contributing to IgG and IgG4 Abnormalities
There are several factors that can contribute to elevated IgG and IgG4 levels:
- Infections: Chronic infections can stimulate the immune system, leading to increased production of immunoglobulins, including IgG. Your recent health issues, such as the car accident and subsequent skin infections, may have contributed to the immune response reflected in your lab results.

- Autoimmune Conditions: Conditions like lupus, rheumatoid arthritis, and other autoimmune diseases can cause elevated IgG levels. The immune system may produce more antibodies in response to perceived threats, even if no actual infection is present.

- Allergies: While IgG is not typically associated with allergic reactions (IgE is the primary antibody involved), some individuals may experience changes in IgG levels due to allergic responses or sensitivities.

Regarding your specific questions about the impact of your recent injuries and dietary habits on your lab results:
- Injuries and Infections: The skin infections and inflammation from your injuries could indeed influence your immune response and lead to elevated IgG levels. The body produces antibodies in response to inflammation and infection, which could explain the lab findings.

- Dietary Factors: Drinking milk before a blood test is unlikely to significantly affect IgG or IgG4 levels. However, certain foods can trigger immune responses in sensitive individuals, but this is more commonly associated with IgE-mediated allergies rather than IgG.

3. Allergies and IgG
Your observation about developing a shrimp allergy as an adult is interesting. Allergies can develop at any age, and while they are typically associated with IgE antibodies, some studies suggest that IgG may also play a role in food sensitivities. However, the relationship between IgG levels and food allergies is still a topic of ongoing research, and elevated IgG levels do not necessarily indicate an allergy.

Conclusion
In summary, elevated IgG and IgG4 levels can indicate an underlying immune disorder that may require long-term management. While the prospect of lifelong medication can be daunting, it is essential to work closely with your healthcare provider to monitor your condition and adjust treatment as necessary. Factors such as infections, autoimmune responses, and even recent injuries can contribute to these abnormalities. Lastly, while developing new allergies is possible, the relationship between IgG levels and allergies is complex and not fully understood. Regular follow-ups and open communication with your healthcare team will be vital in managing your health effectively.

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