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Reviewed by: Dr John Cox, 31 Jul 2015

This article is for Medical Professionals

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find one of our health articles more useful.


In this article

A state of deficiency of plasma gamma globulins and impairment of antibody formation. The most common cause worldwide is malnutrition. Hypogammaglobulinaemia may be primary or secondary:



Hypogammaglobulinaemia, especially more benign forms, may be easily overlooked. Primary antibody deficiency syndromes most commonly present with recurrent infections due to encapsulated bacteria. However, the most common primary antibody deficiency (common variable immunodeficiency) may present with systemic and organ-specific autoimmunity. Hypogammaglobulinaemia is associated with recurrent, persistent and severe infections such as sinusitis, otitis media, conjunctivitis, pneumonia, meningitis, septic arthritis, failure to thrive and a chronic asymmetrical polyarthritis. Assessment should include a family history of any health problems suggesting possible immunodeficiency. The Primary Immunodeficiency Association lists the following as warning signs of a primary immunodeficiency:

Other features of hypogammaglobulinaemia include:

Differential diagnosis


Umbilical cord blood can be used in the prenatal diagnosis of some of the inherited causes of hypogammaglobulinaemia.




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Further reading and references

; Primary antibody deficiency syndromes. Curr Opin Hematol. 2010 Jul17(4):356-61.

; Evaluation of primary immunodeficiency disease in children. Am Fam Physician. 2013 Jun 187(11):773-8.

; Hypogammaglobulinaemia. Immunol Allergy Clin North Am. 2008 Nov28(4):691-713, vii.

In 2008, Milner and colleagues [ 87 ] demonstrated that T cells in subjects with AD-HIES failed to produce interleukin (IL)-17 (but not interferon gamma) after mitogenic stimulation with staphylococcal enterotoxin B or after antigenic stimulation with Candida albicans or streptokinase. Purified naïve T cells were unable to differentiate into IL-17 producing the T helper (Th17) cells in vitro and had a lower expression of the retinoid-related orphan receptor (ROR)-γt, which is consistent with the crucial role of STAT3 signaling in the generation of Th17 cells. These Th17 cells have emerged as an important subset of helper T cells being critical in the clearance of fungal and extracellular bacterial infections. The Th17 cytokines, IL-17 (IL-17A) and IL-17F form biologically active homo- or heterodimers. Il-17 initiates nuclear factor kappa B (NF-κB) activation, leading to the transcription of multiple target genes involved in innate immunity. These include chemokines, such as CXCL8 (IL-8) and CCL20, the cytokines IL-6, tumor necrosis factor alpha (TNF-α), granulocyte- and granulocyte-macrophage colony-stimulating factor (G-CSF and GM-CSF, respectively), acute phase proteins such as C-reactive protein, antimicrobial peptides and mucins [ 88 ]. Thus, IL-17 plays an important role in antimicrobial defenses by recruiting and expanding the neutrophil lineage and producing antimicrobial peptides. The proinflammatory cytokines produced by Th17 cells include TNFα, IL-22 and IL-26, which are involved in innate immunity, and IL-6 which directs CD4+T cells differentiation towards the Th17 lineage. IL-22 has been associated with the generation of defensins, acute phase proteins and inflammatory cytokines [ 89 ]. This multidirectional, fundamental role of Th17 cells, including cells with specificities against candidal antigens explains the pattern of infection susceptibility characteristic of mutated HIES patients. In the recent report by Conti et al [ 90 ] a decrease of salivary antimicrobial peptides, such as β-defensin 2 and Histatins has been demonstrated in AD-HIES patients, providing a mechanism for the severe susceptibility to oropharyngeal candidiasis. This finding supports this hypothesis of the crucial role of the Th17-dependent responses in immunity to .

Immune assessments of mutated AR-HIES patients reveal T cell lymphopenia with low counts of both CD4+ and CD8+ T cells, as well as impaired T cell expansion from activated peripheral blood mononuclear cells in vitro. In autosomal recessive HIES eosinophilia and the elevated serum IgE may be more pronounced than in AD-HIES []. In contrast to the latter syndrome, DOCK8 deficiency is associated with low IgM concentrations and impaired generation of a durable secondary antibody response to specific antigens, which accounts for the functional antibody abnormalities []. In a single patient with AR-HIES due to mutation, a normal number of lymphocytes was observed.

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1940's / Chamber Music / Classical Music / Sunday Gramophone / Weekend Gramophone

Hugo Kauder - Very prolific, highly enjoyable, very accessible, virtually ignored.

by gordonskene · Jul 8, 2018

Hugo Kauder – Very prolific, highly enjoyable, very accessible, virtually ignored.


Hugo Kauder – Piano Sonata Number 2 – Lilian Kallir, Piano – Hugo Kauder Society Vol. 2 (circa 1946) 78 rpm set – Gordon Skene Sound Collection –

The music of Hugo Kauder this weekend. It occurred to me that, calling this feature the Weekly Gramophone has been a misnomer these past several years. I always seem to play radio recordings, airchecks, transcriptions of various historic performers or performances, but never have I actually offered any honest-to-god Shellac recordings (i.e. 78’s) which constitute real Gramophone recordings.

This week it changes – and it changes by way of a very rare set of discs I’ve had on the shelf for a very long time; a performance of the Piano Sonata Number 2 by the 20th Century Austrian composer Hugo Kauder, performed by the legendary Lilian Kallir in this circa 1946-1947 set of 78s which were initially released as part of the Hugo Kauder Society in the late 1940s. Also included are Two Melodies from 21 Melodies For Piano after the Sonata.

For your information, by way of The Hugo Kauder Society:

Kauder was born June 9, 1888 in Tobitschau, Moravia, now Tovacov, Czech Republic. His father Ignaz Kauder was Oberlehrer (principal) of the local German language elementary school. As a boy, Hugo Kauder had violin lessons with the local teacher, who eventually dismissed him when he had taught him everything he knew. These lessons were his only formal training in music.

In 1905, Kauder moved to Vienna to study engineering but often skipped school with classmate Egon Lustgarten to study scores in the Imperial Court Library. Of particular interest to him were several volumes of Denkmäler der Tonkunst in Österreich (Monuments of Music in Austria), mainly works of Flemish composers of the 15th and 16th centuries.

From 1911 to 1917, Kauder played violin in the Wiener Tonkuenstler Orchester under such conductors as Ferdinand Loewe, Franz Schalk, Arthur Nikisch, and Richard Strauss. There he began a lifelong friendship with Dutch horn player Willem Valkenier (1887-1986), inspiring his numerous horn compositions.

From 1917 to 1922, Kauder was the violist of the Gottesmann Quartet.

In 1919, he met poet and philosopher Rudolf Pannwitz (1886-1969). Though he could not play an instrument, Pannwitz composed settings of classic poems, following his idea “quite unconventional at the time” that composers should find and reveal the music latent in texts, rather than creating the musical setting at will. Kauder adopted and elaborated this approach to vocal music and regarded Pannwitz as a life-long mentor.

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