Many parents or relatives attribute the frequent illnesses of a child to “low immunity”.
A weakened immune system or reduced immunity can certainly contribute to recurrent chest infections, skin infections, persistent fevers, or unexplained fatigue. Still, in some children, the real problem may be far more complex. Sometimes the immune system itself may not be functioning the way it should.
When getting sick often is more than just “getting sick often”
Paediatric specialists are increasingly seeing children with recurrent pneumonia, recurrent skin abscesses, non-healing mouth ulcers, prolonged fevers or infections that relapse despite treatment. At the same time, some children may develop swollen joints, skin rashes, muscle weakness, kidney inflammation or unexplained weight loss, features that may point toward autoimmune conditions such as juvenile idiopathic arthritis, childhood lupus, juvenile dermatomyositis or vasculitis. At first, these symptoms may seem unrelated, which is why diagnosis is often delayed.
Double challenge of the immune system explained
These cases are especially difficult because these children often have two problems at the same time. If their immune system gets too active, it could attack their own tissues, but if it’s not active enough, it won’t be able to defend the body against real infections.
To add to this complexity, medicines used to control autoimmune inflammation, such as steroids, methotrexate, biologics or JAK inhibitors, can further reduce immune defences. These treatments are often essential to prevent permanent damage to organs, but they can also make the child more vulnerable to infections such as tuberculosis, chickenpox, influenza, pneumococcal infections, and certain fungal diseases. Therefore, a fever in a child on immunosuppressive therapy is never a routine occurrence and usually necessitates prompt medical evaluation.
When there is a genetic cause lurking below the surface
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Another important possibility that doctors consider in such children is Primary Immune Deficiency (PID, also known as Inborn Errors of Immunity). These are inherited disorders of the immune system. Today, more than 550 different immune deficiency conditions have been identified worldwide, and experts estimate that nearly 1 in 1,200 people may be affected. In a country like India, this means a lot of children living with undiagnosed immune disorders.
If autoimmune symptoms start very early, if infections are severe or recurrent, or if there is a strong family history, doctors may look for an underlying immune defect.
How early diagnosis is changing the odds
The good news is that diagnosis is much easier now than it was just a decade ago. Now specialists can better and more accurately identify these conditions earlier using blood-based immunology work-ups, antibody testing, immune cell profiling and genetic testing.
When a diagnosis is made, treatment is very much individualised. Some children may benefit from immunoglobulin replacement therapy (IVIG), whilst others may require targeted biologic therapies to control immune dysregulation. Selected cases can be cured long-term by bone marrow transplantation.
The future of paediatric immunology lies in early recognition, better awareness among frontline doctors and wider access to genetic diagnosis.
The author is a lead consultant, Paediatric Immunology, Rheumatology & Bone Marrow Transplant at Manipal Hospital, Yelahanka.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
