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Perspective: Evolving Concepts in the Diagnosis and Understanding of Common Variable Immunodeficiency Disorders (CVID)

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Abstract

Common variable immunodeficiency disorders (CVID) are the most frequent symptomatic primary immune deficiency in adults. At this time, the causes of these conditions are unknown. Patients with CVID experience immune system failure consequent to late onset antibody failure. They have increased susceptibility to infections and are also at risk of severe autoimmune and inflammatory disorders as a result of immune dysregulation. An increasing number of monogenic causes as well as a digenic disorder have been described in patients with a CVID phenotype. If a causative mutation is identified, patients are removed from the umbrella diagnosis of CVID and are reclassified as having a CVID-like disorder, resulting from a specific mutation. In non-consanguineous populations, next-generation sequencing (NGS) identifies a genetic cause in approximately 25% of patients with a CVID phenotype. It is six years since we published our diagnostic criteria for CVID. There is ongoing debate about diagnostic criteria, the role of vaccine responses and genetic analysis in the diagnosis of CVID. There have been several recent studies, which have addressed some of these uncertainties. Here we review this new evidence from the perspective of our CVID diagnostic criteria and speculate on future approaches, which may assist in identifying and assessing this group of enigmatic disorders.

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We thank A+ Trust, AMRF, ASCIA and IDFNZ for grant support.

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  1. Department of Virology and Immunology, Auckland City Hospital, Auckland, 1010, New Zealand

    Rohan Ameratunga

  2. Department of Clinical Immunology, Auckland City Hospital, Auckland, 1010, New Zealand

    Rohan Ameratunga & See-Tarn Woon

  3. Department of Molecular Medicine and Pathology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand

    Rohan Ameratunga

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Correspondence to Rohan Ameratunga.

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Ethics approval was not required for this review article. Studies referred to in this publication have complied with ethics requirements of the Health and Disability Ethics Committee (HDEC) of the NZ Ministry of Health and ADHB ethics committee. We thank our patients for participating in these studies for the benefit of others.

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Ameratunga, R., Woon, ST. Perspective: Evolving Concepts in the Diagnosis and Understanding of Common Variable Immunodeficiency Disorders (CVID). Clinic Rev Allerg Immunol 59, 109–121 (2020). https://doi.org/10.1007/s12016-019-08765-6

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