Elevated IgG and IgG-4 Levels: Causes and Solutions

Elevated levels of IgG and IgG4 immunoglobulins?

Hello Doctor: My father had blood tests in the pancreatic department showing elevated levels of IgG: 1910 and IgG-4: 238.
The pancreatic specialist advised us to consult a rheumatologist to determine the cause of the elevated globulin levels.
After two months of medication from the rheumatologist, there has been no decrease in IgG levels.
I would like to ask:
1.
What methods can directly identify the primary cause of elevated globulin levels? What conditions could lead to increased IgG and IgG-4 levels? Additionally, there is a test result showing D-Dimer at 0.62, which is also above the normal range.
I found online that this is related to thrombolysis issues; which specialty should we consult for this, or what additional tests can be performed?
2.
My father has been taking Hydroxychloroquine Sulfate (200 mg) prescribed by the rheumatologist, but he has been feeling worse, experiencing itching and stomach pain.
He has reported this to the doctor, who mentioned that this medication is the mildest option available.
Are there alternative methods to lower the IgG levels?
3.
My father has a history of gastrointestinal issues and occasionally coughs.
He previously underwent an endoscopy that revealed minor lesions, which have been treated, and a chest X-ray showed no problems.
Could these two issues be contributing to the elevated IgG levels?
4.
I read in a report that individuals with immune globulin issues should avoid supplements like Brazilian mushrooms and propolis.
However, he has recently been consuming ACAI berry powder.
Is this suitable for him?
Thank you very much.

Qi Qi, 70~79 year old female. Ask Date: 2013/11/07

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your message.
The diagnosis of IgG4-related disease cannot rely solely on the concentrations of IgG and IgG4 in the blood.
Since the elevation of IgG and IgG4 can be due to various reasons beyond pancreatitis, it is essential to consider the overall clinical picture to avoid misdiagnosis.
Therefore, if there are biopsy samples from functionally abnormal tissues or organs, they would provide more valuable reference information.
I will address your questions one by one:
1.
There are numerous reasons for the elevation of IgG and IgG4, and it is crucial to correlate these findings with clinical symptoms.
You should discuss this with your physician.
The reference values for D-Dimer in our hospital differ from your results, so I may not be able to provide you with a definitive answer.
However, D-Dimer is clinically associated with thromboembolic diseases, such as venous thromboembolism or pulmonary embolism, and it may be worthwhile to consult a cardiologist if necessary.
That said, the reference value of D-Dimer is not very high, and it is best interpreted in conjunction with clinical symptoms.
2.
Although Belimumab is a relatively mild medication, some individuals may still experience side effects.
You should discuss the possibility of changing medications with your physician.
If this is the case, there are indeed other treatment options available.
3.
Mild infections can indeed lead to elevated immunoglobulin levels, which is why one should not rely solely on laboratory data.
It is important to evaluate the patient's symptoms as a whole to determine the relevance of the test results.
If there are only abnormal indices without any symptoms, it may be reasonable to consider regular monitoring of laboratory data.
4.
It is challenging to provide specific dietary advice, as the available information is quite limited.
However, for patients with immune dysfunction, we typically do not recommend self-administering foods that may enhance immune function, as this could exacerbate underlying immune issues and complicate treatment.
The key is to discuss these matters with your physician, especially when patients or their families have concerns.
The healthcare provider has the responsibility to provide answers and reassurance, so do not hesitate to ask your physician.
Wishing you health and peace.

Ministry of Health and Welfare, Department of Allergy, Immunology, and Rheumatology.
We care about you.

Reply Date: 2013/11/07

More Info

Elevated levels of IgG and IgG4 can be concerning and warrant a thorough investigation to determine the underlying causes. In your father's case, with IgG at 1910 mg/dL and IgG4 at 238 mg/dL, it is essential to approach this situation systematically.

1. Identifying the Cause of Elevated IgG and IgG4: Elevated IgG and IgG4 levels can be associated with various conditions, including autoimmune diseases, chronic infections, and certain malignancies. Common causes include IgG4-related disease, chronic pancreatitis, and other inflammatory conditions. To pinpoint the exact cause, a detailed clinical history, physical examination, and possibly imaging studies or biopsies may be necessary. A rheumatologist or an immunologist can provide insights into autoimmune conditions that may be contributing to these elevated levels. Additionally, the D-Dimer level of 0.62 mg/L, which is above the normal range, suggests a potential clotting issue, possibly indicating a thrombotic event. It would be prudent to consult a hematologist for further evaluation of this finding, especially if there are symptoms like swelling, pain, or shortness of breath.

2. Medication Side Effects and Alternatives: Hydroxychloroquine (Plaquenil) is often prescribed for autoimmune conditions and is generally well-tolerated, but it can cause side effects in some individuals, such as gastrointestinal discomfort and skin reactions. If your father is experiencing significant side effects, it is crucial to communicate this with his healthcare provider. There may be alternative medications or treatment strategies available that could help manage his condition without causing adverse effects. Additionally, lifestyle modifications, such as dietary changes and stress management, may also play a role in managing autoimmune conditions.

3. Impact of Gastrointestinal Issues on IgG Levels: Gastrointestinal problems, such as gastritis or ulcers, can contribute to systemic inflammation, which may lead to elevated immunoglobulin levels. While these issues alone may not directly cause elevated IgG levels, they can exacerbate underlying conditions or contribute to a chronic inflammatory state. It is essential to manage these gastrointestinal symptoms effectively, as they can impact overall health and immune function.

4. Dietary Considerations: Regarding dietary supplements like acai berry powder, it is essential to approach these with caution, especially in individuals with immune system issues. While acai berries are rich in antioxidants, they may not be suitable for everyone, particularly those with specific immune conditions. It is advisable to consult with a healthcare provider or a nutritionist before introducing new supplements into your father's diet, especially if there are concerns about immune function.

In summary, elevated IgG and IgG4 levels require a comprehensive evaluation to determine the underlying cause. Collaboration with specialists in rheumatology, hematology, and possibly gastroenterology will be crucial in managing your father's health. Regular monitoring of his immunoglobulin levels and symptoms will also be important in guiding treatment decisions. Open communication with healthcare providers about any side effects from medications and dietary choices will help ensure a tailored approach to his care.

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