U.S. flag

An official website of the United States government

Format

Send to:

Choose Destination

X-linked agammaglobulinemia(XLA)

MedGen UID:
65123
Concept ID:
C0221026
Disease or Syndrome
Synonyms: Agammaglobulinemia, Bruton tyrosine kinase; Agammaglobulinemia, BTK; AGAMMAGLOBULINEMIA, X-LINKED, TYPE 1; Bruton's agammaglobulinemia; Bruton-type agammaglobulinemia; BTK-deficiency; IMMUNODEFICIENCY 1; XLA
SNOMED CT: X-linked agammaglobulinemia (65880007); Bruton's type agammaglobulinemia (65880007); X linked agammaglobulinemia (65880007); Bruton's agammaglobulinemia (65880007); XLA - X-linked agammaglobulinemia (65880007); Bruton's hypogammaglobulinemia (65880007)
Modes of inheritance:
X-linked recessive inheritance
MedGen UID:
375779
Concept ID:
C1845977
Finding
Source: Orphanet
A mode of inheritance that is observed for recessive traits related to a gene encoded on the X chromosome. In the context of medical genetics, X-linked recessive disorders manifest in males (who have one copy of the X chromosome and are thus hemizygotes), but generally not in female heterozygotes who have one mutant and one normal allele.
Not genetically inherited
MedGen UID:
988794
Concept ID:
CN307044
Finding
Source: Orphanet
clinical entity without genetic inheritance.
 
Gene (location): BTK (Xq22.1)
 
Monarch Initiative: MONDO:0010421
OMIM®: 300755
Orphanet: ORPHA47

Disease characteristics

Excerpted from the GeneReview: X-Linked Agammaglobulinemia
X-linked agammaglobulinemia (XLA) is characterized by recurrent bacterial infections in affected males in the first two years of life. Recurrent otitis is the most common infection prior to diagnosis. Conjunctivitis, sinopulmonary infections, diarrhea, and skin infections are also frequently seen. Approximately 60% of individuals with XLA are recognized as having immunodeficiency when they develop a severe, life-threatening infection such as pneumonia, empyema, meningitis, sepsis, cellulitis, or septic arthritis. S pneumoniae and H influenzae are the most common organisms found prior to diagnosis and may continue to cause sinusitis and otitis after diagnosis and the initiation of gammaglobulin substitution therapy. Severe, difficult-to-treat enteroviral infections (often manifesting as dermatomyositis or chronic meningoencephalitis) can be prevented by this treatment. The prognosis for individuals with XLA has improved markedly in the last 25 years as a result of earlier diagnosis, the development of preparations of gammaglobulin that allow normal concentrations of serum immunoglobulin G to be achieved, and more liberal use of antibiotics. [from GeneReviews]
Authors:
CI Edvard Smith  |  Anna Berglöf   view full author information

Additional descriptions

From OMIM
X-linked agammaglobulinemia is an immunodeficiency characterized by failure to produce mature B lymphocytes and associated with a failure of Ig heavy chain rearrangement. The defect in this disorder resides in BTK, also known as BPK or ATK, a key regulator in B-cell development (Rawlings and Witte, 1994). The X-linked form accounts for approximately 85 to 90% of cases of the disorder. Also see 300310. The remaining 15% of cases constitute a heterogeneous group of autosomal disorders (Lopez Granados et al., 2002; Ferrari et al., 2007). Genetic Heterogeneity of Agammaglobulinemia/Hypogammaglobulinemia A form of X-linked hypogammaglobulinemia (IMD61; 300310) is caused by mutation in the SH3KBP1 gene (300374) on chromosome Xq22. See agammaglobulinemia-1 (AGM1; 601495) for a discussion of genetic heterogeneity of autosomal forms of agammaglobulinemia.  http://www.omim.org/entry/300755
From MedlinePlus Genetics
X-linked agammaglobulinemia (XLA) is a condition that affects the immune system and occurs almost exclusively in males. It is part of a group of disorders called primary immunodeficiencies (or inborn errors of immunity), in which part of the immune system does not function as it should. People with XLA have very few B cells, which are specialized white blood cells that help protect the body against infection. B cells can mature into the cells that produce special proteins called antibodies or immunoglobulins. Antibodies attach to specific foreign particles and germs, marking them for destruction. Individuals with XLA are more susceptible to infections because their body makes very few antibodies.

Children with XLA are usually healthy for the first 1 or 2 months of life because they are protected by antibodies acquired before birth from their mother. After this time, the maternal antibodies are cleared from the body, and the affected child begins to develop recurrent infections. .cf0{font-style:italic;font-family:Segoe UI;font-size:9pt;}Children with XLA generally take longer to recover from infections, and infections often occur again, even in children who are taking antibiotic medications.

The most common bacterial infections that occur in people with XLA are lung infections (pneumonia and bronchitis), ear infections (otitis), pink eye (conjunctivitis), and sinus infections (sinusitis). Infections that cause chronic diarrhea are also common. Recurrent infections can lead to organ damage. .cf0{font-style:italic;font-family:Segoe UI;font-size:9pt;}Treatments that replace antibodies can help prevent infections, improving the quality of life for people with XLA.  https://medlineplus.gov/genetics/condition/x-linked-agammaglobulinemia

Clinical features

From HPO
Recurrent urinary tract infections
MedGen UID:
120466
Concept ID:
C0262655
Disease or Syndrome
Repeated infections of the urinary tract.
Cor pulmonale
MedGen UID:
18765
Concept ID:
C0034072
Disease or Syndrome
Right-sided heart failure resulting from chronic hypertension in the pulmonary arteries and right ventricle.
Chronic diarrhea
MedGen UID:
96036
Concept ID:
C0401151
Finding
The presence of chronic diarrhea, which is usually taken to mean diarrhea that has persisted for over 4 weeks.
Enteroviral hepatitis
MedGen UID:
334558
Concept ID:
C1843995
Disease or Syndrome
Inflammation of the liver due to infection with enterovirus.
Hepatocellular carcinoma
MedGen UID:
389187
Concept ID:
C2239176
Neoplastic Process
Hepatocellular carcinoma is the major histologic type of malignant primary liver neoplasm. It is the fifth most common cancer and the third most common cause of death from cancer worldwide. The major risk factors for HCC are chronic hepatitis B virus (HBV) infection, chronic hepatitis C virus (HCV) infection, prolonged dietary aflatoxin exposure, alcoholic cirrhosis, and cirrhosis due to other causes. Hepatoblastomas comprise 1 to 2% of all malignant neoplasms of childhood, most often occurring in children under 3 years of age. Hepatoblastomas are thought to be derived from undifferentiated hepatocytes (Taniguchi et al., 2002).
Hearing impairment
MedGen UID:
235586
Concept ID:
C1384666
Disease or Syndrome
A decreased magnitude of the sensory perception of sound.
Delayed speech and language development
MedGen UID:
105318
Concept ID:
C0454644
Finding
A degree of language development that is significantly below the norm for a child of a specified age.
Anemia
MedGen UID:
1526
Concept ID:
C0002871
Disease or Syndrome
A reduction in erythrocytes volume or hemoglobin concentration.
Infective arthritis
MedGen UID:
13918
Concept ID:
C0003869
Disease or Syndrome
The inflammation of one or more joints caused by any infectious pathogen within the joint space. Symptoms include pain, stiffness, and decreased range of motion in the affected joint.
Bronchiectasis
MedGen UID:
14234
Concept ID:
C0006267
Disease or Syndrome
Persistent abnormal dilatation of the bronchi owing to localized and irreversible destruction and widening of the large airways.
Bronchiolitis obliterans with obstructive pulmonary disease
MedGen UID:
665
Concept ID:
C0006272
Disease or Syndrome
Inflammation and fibrosis of the bronchioles leading to partial or complete obstruction of these airways.
Wheezing
MedGen UID:
21917
Concept ID:
C0043144
Sign or Symptom
A high-pitched whistling sound associated with labored breathing.
Recurrent sinusitis
MedGen UID:
107919
Concept ID:
C0581354
Disease or Syndrome
A recurrent form of sinusitis.
Recurrent pneumonia
MedGen UID:
195802
Concept ID:
C0694550
Disease or Syndrome
An increased susceptibility to pneumonia as manifested by a history of recurrent episodes of pneumonia.
Recurrent lower respiratory tract infections
MedGen UID:
756211
Concept ID:
C3163798
Disease or Syndrome
An increased susceptibility to lower respiratory tract infections as manifested by a history of recurrent lower respiratory tract infections.
Agammaglobulinemia
MedGen UID:
168
Concept ID:
C0001768
Disease or Syndrome
A lasting absence of total IgG and total IgA and total IgM in the blood circulation, whereby at most trace quantities can be measured.
Conjunctivitis
MedGen UID:
1093
Concept ID:
C0009763
Disease or Syndrome
Inflammation of the conjunctiva.
Epididymitis
MedGen UID:
4986
Concept ID:
C0014534
Disease or Syndrome
The presence of inflammation of the epididymis.
Meningitis
MedGen UID:
6298
Concept ID:
C0025289
Disease or Syndrome
Inflammation of the meninges.
Prostatitis
MedGen UID:
10965
Concept ID:
C0033581
Disease or Syndrome
The presence of inflammation of the prostate.
Pyoderma
MedGen UID:
18783
Concept ID:
C0034212
Disease or Syndrome
Any manifestation of a skin disease associated with the production of pus.
Sepsis
MedGen UID:
48626
Concept ID:
C0036690
Disease or Syndrome
Systemic inflammatory response to infection.
Decreased circulating IgA concentration
MedGen UID:
57934
Concept ID:
C0162538
Disease or Syndrome
Decreased levels of immunoglobulin A (IgA).
Decreased circulating total IgM
MedGen UID:
116095
Concept ID:
C0239989
Finding
An abnormally decreased level of immunoglobulin M (IgM) in blood.
Recurrent infections
MedGen UID:
65998
Concept ID:
C0239998
Finding
Increased susceptibility to infections.
Infectious encephalitis
MedGen UID:
108917
Concept ID:
C0596773
Disease or Syndrome
A disorder of the brain caused by an infectious agent that presents with fever, headache, and an altered level of consciousness. There may also be focal or multifocal neurologic deficits, and focal or generalized seizure activity.
Recurrent otitis media
MedGen UID:
155436
Concept ID:
C0747085
Disease or Syndrome
Increased susceptibility to otitis media, as manifested by recurrent episodes of otitis media.
Decreased circulating IgE concentration
MedGen UID:
1714318
Concept ID:
C0853668
Finding
An abnormally decreased level of immunoglobulin E (IgE) in blood.
Neutropenia
MedGen UID:
163121
Concept ID:
C0853697
Finding
An abnormally low number of neutrophils in the peripheral blood.
B lymphocytopenia
MedGen UID:
340780
Concept ID:
C1855067
Finding
An abnormal decrease from the normal count of B cells.
T lymphocytopenia
MedGen UID:
419385
Concept ID:
C2931322
Finding
An abnormally low count of T cells.
Enteroviral dermatomyositis syndrome
MedGen UID:
812990
Concept ID:
C3806660
Finding
Lymph node hypoplasia
MedGen UID:
892318
Concept ID:
C4025683
Finding
Underdevelopment of the lymph nodes.
Complete or near-complete absence of specific antibody response to Haemophilus influenzae type b (Hib) vaccine
MedGen UID:
1692657
Concept ID:
C5139466
Finding
The inability to synthesize postvaccination antibodies against a Haemophilus influenzae type b (Hib) antigen, as measured by antibody titer determination following vaccination.
Decreased circulating IgG concentration
MedGen UID:
1720114
Concept ID:
C5234937
Finding
An abnormally decreased level of immunoglobulin G (IgG) in blood.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVX-linked agammaglobulinemia
Follow this link to review classifications for X-linked agammaglobulinemia in Orphanet.

Professional guidelines

PubMed

Drzymalla E, Green RF, Knuth M, Khoury MJ, Dotson WD, Gundlapalli A
Clin Immunol 2022 Oct;243:109097. Epub 2022 Aug 13 doi: 10.1016/j.clim.2022.109097. PMID: 35973637Free PMC Article
Bestas B, Turunen JJ, Blomberg KE, Wang Q, Månsson R, El Andaloussi S, Berglöf A, Smith CI
Curr Allergy Asthma Rep 2015 Mar;15(3):510. doi: 10.1007/s11882-014-0510-0. PMID: 25638286Free PMC Article
Agarwal S, Mayer L
Clin Gastroenterol Hepatol 2013 Sep;11(9):1050-63. Epub 2013 Mar 13 doi: 10.1016/j.cgh.2013.02.024. PMID: 23501398Free PMC Article

Recent clinical studies

Etiology

Billi B, Cholley P, Grobost V, Clément M, Rieu V, Le Guenno G, Lobbes H
Front Immunol 2024;15:1399180. Epub 2024 Apr 19 doi: 10.3389/fimmu.2024.1399180. PMID: 38707896Free PMC Article
Cousins K, DeFelice N, Jeong S, Feng J, Lee ASE, Rotella K, Sanchez D, Jaber F, Agarwal S, Ho HE, Cunningham-Rundles C
Front Immunol 2022;13:1035571. Epub 2022 Nov 21 doi: 10.3389/fimmu.2022.1035571. PMID: 36479106Free PMC Article
Pal Singh S, Dammeijer F, Hendriks RW
Mol Cancer 2018 Feb 19;17(1):57. doi: 10.1186/s12943-018-0779-z. PMID: 29455639Free PMC Article
Kanegane H, Hoshino A, Okano T, Yasumi T, Wada T, Takada H, Okada S, Yamashita M, Yeh TW, Nishikomori R, Takagi M, Imai K, Ochs HD, Morio T
Allergol Int 2018 Jan;67(1):43-54. Epub 2017 Jul 3 doi: 10.1016/j.alit.2017.06.003. PMID: 28684198
Cham B, Bonilla MA, Winkelstein J
Semin Hematol 2002 Apr;39(2):107-12. doi: 10.1053/shem.2002.31916. PMID: 11957193

Diagnosis

Martin de Frémont G, Chabrolles H, Mirand A, L'Honneur AS, Mélé N, Dunogue B, Boutboul D, Farhat M, Hachulla E, Lazrek M, Rieu V, Mathian A, Chaussade H, Ruet A, Burrel S, Coury-Lucas F, Schuffenecker I, Lemaignen A, Stefic K, le Besnerais M, Carrette M, Mouthon L, Avettand-Fenoel V, Terrier B, Hadjadj J
RMD Open 2024 May 20;10(2) doi: 10.1136/rmdopen-2023-004036. PMID: 38772678Free PMC Article
Cardenas-Morales M, Hernandez-Trujillo VP
Clin Rev Allergy Immunol 2022 Aug;63(1):22-35. Epub 2021 Jul 9 doi: 10.1007/s12016-021-08870-5. PMID: 34241796Free PMC Article
Griffin DD, Dolen WK
Curr Allergy Asthma Rep 2020 Aug 21;20(11):64. doi: 10.1007/s11882-020-00963-z. PMID: 32821980
Kanegane H, Hoshino A, Okano T, Yasumi T, Wada T, Takada H, Okada S, Yamashita M, Yeh TW, Nishikomori R, Takagi M, Imai K, Ochs HD, Morio T
Allergol Int 2018 Jan;67(1):43-54. Epub 2017 Jul 3 doi: 10.1016/j.alit.2017.06.003. PMID: 28684198
Rijkers GT, Damoiseaux JG, Hooijkaas H
Immunol Lett 2014 Dec;162(2 Pt B):127-33. Epub 2014 Oct 16 doi: 10.1016/j.imlet.2014.10.016. PMID: 25455599

Therapy

Martin de Frémont G, Chabrolles H, Mirand A, L'Honneur AS, Mélé N, Dunogue B, Boutboul D, Farhat M, Hachulla E, Lazrek M, Rieu V, Mathian A, Chaussade H, Ruet A, Burrel S, Coury-Lucas F, Schuffenecker I, Lemaignen A, Stefic K, le Besnerais M, Carrette M, Mouthon L, Avettand-Fenoel V, Terrier B, Hadjadj J
RMD Open 2024 May 20;10(2) doi: 10.1136/rmdopen-2023-004036. PMID: 38772678Free PMC Article
Pal Singh S, Dammeijer F, Hendriks RW
Mol Cancer 2018 Feb 19;17(1):57. doi: 10.1186/s12943-018-0779-z. PMID: 29455639Free PMC Article
Roskoski R Jr
Pharmacol Res 2016 Nov;113(Pt A):395-408. Epub 2016 Sep 15 doi: 10.1016/j.phrs.2016.09.011. PMID: 27641927
Yang L, Wu EY, Tarrant TK
Curr Allergy Asthma Rep 2016 Jul;16(8):55. doi: 10.1007/s11882-016-0632-7. PMID: 27401913
Samuels J, Ng YS, Coupillaud C, Paget D, Meffre E
Ann N Y Acad Sci 2005 Dec;1062:116-26. doi: 10.1196/annals.1358.014. PMID: 16461794

Prognosis

Gomes AMC, Farias GB, Trombetta AC, Godinho-Santos A, Parreira I, Gonçalves HD, Simões ML, Aguiar P, Deveza MM, Inácio J, Sousa AE, da Silva SL
Eur J Haematol 2023 Feb;110(2):209-212. Epub 2022 Oct 19 doi: 10.1111/ejh.13881. PMID: 36208028Free PMC Article
Smith CIE, Zain R, Österborg A, Palma M, Buggert M, Bergman P, Bryceson Y
Scand J Immunol 2022 Apr;95(4):e13153. Epub 2022 Mar 16 doi: 10.1111/sji.13153. PMID: 35244285Free PMC Article
Cardenas-Morales M, Hernandez-Trujillo VP
Clin Rev Allergy Immunol 2022 Aug;63(1):22-35. Epub 2021 Jul 9 doi: 10.1007/s12016-021-08870-5. PMID: 34241796Free PMC Article
Grammatikos A, Donati M, Johnston SL, Gompels MM
Front Immunol 2021;12:731643. Epub 2021 Aug 30 doi: 10.3389/fimmu.2021.731643. PMID: 34527001Free PMC Article
Kainulainen L, Varpula M, Liippo K, Svedström E, Nikoskelainen J, Ruuskanen O
J Allergy Clin Immunol 1999 Nov;104(5):1031-6. doi: 10.1016/s0091-6749(99)70085-0. PMID: 10550749

Clinical prediction guides

Smith CIE, Zain R, Österborg A, Palma M, Buggert M, Bergman P, Bryceson Y
Scand J Immunol 2022 Apr;95(4):e13153. Epub 2022 Mar 16 doi: 10.1111/sji.13153. PMID: 35244285Free PMC Article
Cardenas-Morales M, Hernandez-Trujillo VP
Clin Rev Allergy Immunol 2022 Aug;63(1):22-35. Epub 2021 Jul 9 doi: 10.1007/s12016-021-08870-5. PMID: 34241796Free PMC Article
Kim W, Kim E, Min H, Kim MG, Eisenbeis VB, Dutta AK, Pavlovic I, Jessen HJ, Kim S, Seong RH
Proc Natl Acad Sci U S A 2019 Jun 25;116(26):12952-12957. Epub 2019 Jun 12 doi: 10.1073/pnas.1821552116. PMID: 31189594Free PMC Article
Busygina K, Denzinger V, Bernlochner I, Weber C, Lorenz R, Siess W
Thromb Haemost 2019 Aug;119(8):1212-1221. Epub 2019 May 14 doi: 10.1055/s-0039-1687877. PMID: 31087308
Rhim JW, Kim KH, Kim DS, Kim BS, Kim JS, Kim CH, Kim HM, Park HJ, Pai KS, Son BK, Shin KS, Oh MY, Woo YJ, Yoo Y, Lee KS, Lee KY, Lee CG, Lee JS, Chung EH, Choi EH, Hahn YS, Park HY, Kim JG
J Korean Med Sci 2012 Jul;27(7):788-93. Epub 2012 Jun 29 doi: 10.3346/jkms.2012.27.7.788. PMID: 22787376Free PMC Article

Recent systematic reviews

Drzymalla E, Green RF, Knuth M, Khoury MJ, Dotson WD, Gundlapalli A
Clin Immunol 2022 Oct;243:109097. Epub 2022 Aug 13 doi: 10.1016/j.clim.2022.109097. PMID: 35973637Free PMC Article
Khan F, Person H, Dekio F, Ogawa M, Ho HE, Dunkin D, Secord E, Cunningham-Rundles C, Ward SC
J Allergy Clin Immunol Pract 2021 Sep;9(9):3466-3478. Epub 2021 May 21 doi: 10.1016/j.jaip.2021.04.070. PMID: 34029777Free PMC Article
Mazza JM, Lin SY
Int Forum Allergy Rhinol 2016 Oct;6(10):1029-1033. Epub 2016 May 17 doi: 10.1002/alr.21789. PMID: 27187624

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.
    • Bookshelf
      See practice and clinical guidelines in NCBI Bookshelf. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Recent activity

    Your browsing activity is empty.

    Activity recording is turned off.

    Turn recording back on

    See more...