Introduction

Overview

Organization

Scope

Moving Forward

PART I: THE ESSENTIALS

Chapter 1. The Essentials on Primary Immunodeficiency: Guidelines

Overview

What Is Primary Immunodeficiency (PI)?

Where Do Primary Immunodeficiency Diseases Come From?

The Immune Defenses

Types of White Blood Cells

Genes and PI

Germs

Signs and Symptoms

The 10 Warning Signs of Primary Immunodeficiency

DNA, Genes, and Chromosomes

Patterns of Inheritance

Diagnosing PI

Treatments for PI

Important Precautions

Primary Immunodeficiency Diseases: Some Examples

B Cell (Antibody) Deficiencies

Combined T Cell and B Cell (Antibody) Deficiencies

Severe Combined Immunodeficiency (SCID)

Partial Combined Immunodeficiencies

T Cell Deficiencies

Defective Phagocytes

Complement Deficiencies

Deficiences/Cause Unknown

Research In Progress

Future Research Challenges

Resources

More Guideline Sources

Vocabulary Builder

Chapter 2. Seeking Guidance

Overview

Associations and Primary Immunodeficiency

Finding More Associations

Finding Doctors

Finding a Pediatrician

Selecting Your Doctor

Working with Your Child’s Doctor

Broader Health-Related Resources

Vocabulary Builder

Chapter 3. Clinical Trials and Primary Immunodeficiency

Overview

Recent Trials on Primary Immunodeficiency

Benefits and Risks

Keeping Current on Clinical Trials

General References

Vocabulary Builder

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

Chapter 4. Studies on Primary Immunodeficiency

Overview

The Combined Health Information Database

Federally-Funded Research on Primary Immunodeficiency

E-Journals: PubMed Central

The National Library of Medicine: PubMed

Vocabulary Builder

Chapter 5. Books on Primary Immunodeficiency

Overview

Book Summaries: Online Booksellers

The National Library of Medicine Book Index

Chapters on Primary Immunodeficiency

General Home References

Vocabulary Builder

Chapter 6. Periodicals and News on Primary Immunodeficiency

Overview

News Services & Press Releases

Newsletters on Primary Immunodeficiency

Newsletter Articles

Academic Periodicals covering Primary Immunodeficiency

Vocabulary Builder

Chapter 7. Physician Guidelines and Databases

Overview

NIH Guidelines

NIH Databases

Other Commercial Databases

The Genome Project and Primary Immunodeficiency

Specialized References

PART III. APPENDICES

Appendix A. Researching Your Child’s Medications

Overview

Your Child’s Medications: The Basics

Learning More about Your Child’s Medications

Commercial Databases

Contraindications and Interactions (Hidden Dangers)

A Final Warning

General References

Vocabulary Builder

Appendix B. Researching Alternative Medicine

Overview

What Is CAM?

What Are the Domains of Alternative Medicine?

Can Alternatives Affect My Child’s Treatment?

Finding CAM References on Primary Immunodeficiency

Additional Web Resources

General References

Vocabulary Builder

Appendix C. Researching Nutrition

Overview

Food and Nutrition: General Principles

Finding Studies on Primary Immunodeficiency

Federal Resources on Nutrition

Additional Web Resources

Vocabulary Builder

Appendix D. Finding Medical Libraries

Overview

Preparation

Finding a Local Medical Library

Medical Libraries Open to the Public

Appendix E. Your Child’s Rights and Insurance

Overview

Your Child’s Rights as a Patient

Parent Responsibilities

Choosing an Insurance Plan

Medicaid

NORD’s Medication Assistance Programs

Additional Resources

ONLINE GLOSSARIES

Online Dictionary Directories

PRIMARY IMMUNODEFICIENCY GLOSSARY

General Dictionaries and Glossaries

INDEX

Overview

Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.” The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that all parents incorporate education into the treatment process. According to the AHRQ:

Finding out more about your [child’s] condition is a good place to start. By contacting groups that support your [child’s] condition, visiting your local library, and searching on the Internet, you can find good information to help guide your decisions for your [child’s] treatment. Some information may be hard to find—especially if you don't know where to look.

As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist parents in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning:

The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.

Since the late 1990s, physicians have seen a general increase in parent Internet usage rates. Parents frequently enter their children’s doctor's offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding children through sound therapies. The Official Parent’s Sourcebook on Primary Immunodeficiency has been created for parents who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to primary immunodeficiency, from the essentials to the most advanced areas of research.

The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peer-reviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on primary immunodeficiency.

Given parents’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-of-charge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current.

In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process.

We must emphasize that no sourcebook on primary immunodeficiency should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your child’s best option. This sourcebook is no exception. Each child is unique. Deciding on appropriate options is always up to parents in consultation with their children’s physicians and healthcare providers.

Organization

This sourcebook is organized into three parts. Part I explores basic techniques to researching primary immunodeficiency (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other parent networks dedicated to primary immunodeficiency. It also gives you sources of information that can help you find a doctor in your local area specializing in treating primary immunodeficiency. Collectively, the material presented in Part I is a complete primer on basic research topics for primary immunodeficiency.

Part II moves on to advanced research dedicated to primary immunodeficiency. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on primary immunodeficiency. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options.

Part III provides appendices of useful background reading covering primary immunodeficiency or related disorders. The appendices are dedicated to more pragmatic issues facing parents. Accessing materials via medical libraries may be the only option for some parents, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing children with primary immunodeficiency and their families.

Scope

While this sourcebook covers primary immunodeficiency, doctors, research publications, and specialists may refer to your child’s condition using a variety of terms. Therefore, you should understand that primary immunodeficiency is often considered a synonym or a condition closely related to the following:

• Acquired Hypogammaglobulinemia


• Common Variable Hypogammaglobulinemia


• Immunosuppression


• Late-onset Immunoglobulin Deficiency

In addition to synonyms and related conditions, physicians may refer to primary immunodeficiency using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world's illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for primary immunodeficiency:

• 279.3 immunity deficiency, unspecified

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to primary immunodeficiency. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

Moving Forward

Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by parents, patients, or their family members. These generally take a layperson's approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful.

As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian.

Why “Internet age”? When their child has been diagnosed with primary immunodeficiency, parents will often log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. Parents are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with primary immunodeficiency is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion.

While we focus on the more scientific aspects of primary immunodeficiency, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find parent groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you and your child the most options in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your child’s treatment plan.

The Editors