Diagnosis
A diagnosis of repeat and prolonged infections begins with a history of infections, a complete physical and a review of family medical history. This will include an exam of the tonsils, adenoids and lymph nodes in the neck.
If your healthcare professional suspects X-linked agammaglobulinemia (XLA) or another immune system condition, blood samples are sent to a lab to measure levels of:
- Mature B cells.
- Overall antibodies.
- Specific antibodies to common illnesses.
- Antibodies that would be expected based on vaccine history.
If blood tests show a likely diagnosis of XLA, a genetic test is done to find the specific XLA gene mutation.
Treatment
There's no cure for XLA. Treatment goals are:
- Boosting the immune system to prevent infections.
- Treating infections promptly.
- Watching for possible long-term complications at regularly scheduled follow-up visits.
Immunoglobulin (Ig) replacement therapy
Ig replacement therapy is the main treatment for XLA. This therapy gives you antibodies, also called immunoglobulins, from a pool of thousands of donors. This replaces many but not all typical antibodies. It can help fight many different infections.
Ig replacement therapy is given as a shot into the fatty tissues under the skin or through an IV line in a vein. The therapy is done every 2 to 4 weeks to resupply the immune system with antibodies.
The treatment has some limitations. It doesn't replace all types of antibodies made by the immune system. It doesn't protect against uncommon diseases or new germs. It doesn't correct the immune system process of making antibodies, and there isn't the typical boost in antibodies when someone gets an infection.
Possible side effects of injections include burning or swelling at the injection site. Side effects of an IV route may include chills, stiffness, blood pressure changes, nausea, vomiting and general achiness.
Antibiotics
Antibiotics are prescribed to treat infections when they happen. The treatments may have higher doses or longer courses of treatment than is typical. Some people with XLA take antibiotics regularly to prevent infection.
Vaccines
A regular course of vaccines is recommended, as well as annual flu and COVID-19 vaccines. While the immune system will likely not create the typical antibodies to infections, they may trigger other immune system responses that help fight diseases.
People with XLA cannot get vaccines with live viruses. There is some risk for a person with XLA of developing the disease, particularly polio, from this type of vaccine.
Close family members are encouraged to get all regularly scheduled and annual vaccines to help prevent the spread of germs to the person with XLA.
Lifestyle and home remedies
Lifestyle practices can help prevent disease. These are lifelong habits that you can teach and model for your child.
- Wash hands with soap and water:
- Before and after meals.
- Before preparing food.
- After blowing your nose or coughing.
- After using the toilet or changing a diaper.
- After handling garbage.
- Use hand sanitizer when soap and water aren't available.
- Brush teeth twice a day, and see the dentist at least twice a year.
- Avoid crowds, particularly during the cold, flu and COVID-19 season.
- Avoid social events among people who do not get vaccinations.
- Wear masks, particularly during the cold, flu and COVID-19 season.
- Wash produce and handle raw meat carefully.
Coping and support
While most people with XLA can lead typical lives, the condition requires lifelong, consistent illness prevention and care. It may result in absences from school, work or recreational activities. This can cause stress for a child and later, the teen or adult.
Talk with your child about what XLA means in age-appropriate terms. Listen to any worries or concerns your child may have. Help your child learn language to talk about the condition.
The Immune Deficiency Foundation provides resources for families to learn about XLA and other immune system conditions, find community support, and learn coping skills.
Preparing for your appointment
You'll likely start with your child's primary healthcare professional. You also may see specialists in genetics, infectious diseases and immune system conditions.
Here's some information to help you get ready for your appointment.
What you can do
Make a list of your child's:
- Current symptoms.
- History of past illnesses.
- Medicines currently prescribed and prescribed in the past.
- Vaccine history.
- Family history of frequent illnesses or immune system conditions.
Take a family member or friend along, if possible, to take notes and help you remember the information you're given.
What to expect from your doctor
Your healthcare professional is likely to ask you several questions, such as:
- When was your child's last wellness visit?
- What illnesses has your child had?
- How often did your child have each illness?
- How were the illnesses treated?
- What antibiotics were prescribed? How long was the treatment plan?
- What vaccines has your child had?
- Is there a history of an immune system condition in the family? Who was affected?
- Is there a history of frequent infectious disease among the family? Who was affected?
Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Sept. 17, 2026