The Kuwait National Primary Immunodeficiency Registry 2004-2018



Objective: To present the report from the Kuwait National Primary Immunodeficiency Registry between 2004 and 2018. 

Methods: The patients were followed prospectively between January 2004 and December 2018 and their collected data included sociodemographic, diagnosis, clinical presentation, laboratory tests, and treatment. 

Results: A total of 314 PID patients (165 males and 149 females) were registered during the study period. Most of the patients (n = 287, 91.4%) were Kuwaiti nationals and the prevalence among Kuwaitis was 20.27/100,000 with a cumulative incidence of 24.96/100,000 Kuwaitis. The distribution of the patients according to PID categories was as follow: immunodeficiencies affecting cellular and humoral immunity, 100 patients (31.8%); combined immunodeficiencies with associated syndromic features, 68 patients (21.7%); predominantly antibody deficiencies, 56 patients (17.8%); diseases of immune dysregulation, 47 patients (15%); congenital defects of phagocyte number or function, 20 patients (6.4%); autoinflammatory disorders, 1 patient (0.3%); and complement deficiencies, 22 patients (7%). The mean age of the patients at onset of symptoms was 26 months while the mean age at diagnosis was 53 months and the mean delay in diagnosis was 27 months. Most of the patients (n = 272, 86%) had onset of symptoms before the age of 5 years. Parental consanguinity rate within the registered patients was 78% and a positive family history of PID was noticed in 50% of the patients. Genetic testing was performed in 69% of the patients with an overall diagnostic yield of 90%. Mutations were identified in 46 different genes and more than 90% of the reported genetic defects were transmitted by an autosomal recessive pattern. Intravenous immunoglobulins and stem cell transplantation were used in 58% and 25% of the patients, respectively. There were 81 deaths (26%) among the registered patients with a mean age of death of 25 months. Conclusions: PID is not infrequent in Kuwait and the reported prevalence is the highest in the literature with increased proportion of more severe forms. Collaborative efforts including introduction of newborn screening should be implemented to diagnose such cases earlier and improve the quality of life and prevent premature deaths.

Keywords: consanguinity; epidemiology; immunodeficiency; incidence; mortality; prevalence; registry.

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    1. Picard C, Bobby Gaspar H, Al-Herz W, Bousfiha A, Casanova JL, Chatila T, et al. . International union of immunological societies: 2017 primary immunodeficiency diseases committee report on inborn errors of immunity. J Clin Immunol. (2018) 38:96–128. 10.1007/s10875-017-0464-9 - DOI - PMC - PubMed
    1. Seidel MG, Kindle G, Gathmann B, Quinti I, Buckland M, van Montfrans J, et al. . The European Society for Immunodeficiencies (ESID) registry working definitions for the clinical diagnosis of inborn errors of immunity. J Allergy Clin Immunol Pract. (2019) 7:1763–70. 10.1016/j.jaip.2019.02.004 - DOI - PubMed
    1. Al-Tamemi S, Naseem SU, Al-Siyabi N, El-Nour I, Al-Rawas A, Dennison D, et al. . Primary immunodeficiency diseases in oman: 10-year experience in a tertiary care hospital. J Clin Immunol. (2016) 36:785–92. 10.1007/s10875-016-0337-7 - DOI - PubMed
    1. Errante PR, Franco JL, Espinosa-Rosales FJ, Sorensen R, Condino-Neto A. Advances in primary immunodeficiency diseases in Latin America: epidemiology, research, and perspectives. Ann N Y Acad Sci. (2012) 1250:62–72. 10.1111/j.1749-6632.2011.06289.x - DOI - PubMed
    1. Gathmann B, Goldacker S, Klima M, Belohradsky BH, Notheis G, Ehl S, et al. . The German national registry for primary immunodeficiencies (PID). Clin Exp Immunol. (2013) 173:372–80. 10.1111/cei.12105 - DOI - PMC - PubMed
    1. Mahlaoui N, Jais JP, Brosselin P, Mignot C, Beaurain B, Brito C, et al. Prevalence of primary immunodeficiencies in France is underestimated. J Allergy Clin Immunol. (2017) 40:1731–3. 10.1016/j.jaci.2017.06.020 - DOI - PubMed
    1. Ishimura M, Takada H, Doi T, Imai K, Sasahara Y, Kanegane H, et al. . Nationwide survey of patients with primary immunodeficiency diseases in Japan. J Clin Immunol. (2011) 31:968–76. 10.1007/s10875-011-9594-7 - DOI - PubMed
    1. Kirkpatrick P, Riminton S. Primary immunodeficiency diseases in Australia and New Zealand. J Clin Immunol. (2007) 27:517–24. 10.1007/s10875-007-9105-z - DOI - PubMed
    1. Stray-Pedersen A, Abrahamsen TG, Froland SS. Primary immunodeficiency diseases in Norway. J Clin Immunol. (2000) 20:477–85. 10.1023/A:1026416017763 - DOI - PubMed
    1. Mellouli F, Mustapha IB, Khaled MB, Besbes H, Ouederni M, Mekki N, et al. . Report of the Tunisian Registry of Primary Immunodeficiencies: 25-Years of Experience (1988-2012). J Clin Immunol. (2015) 35:745–53. 10.1007/s10875-015-0206-9 - DOI - PubMed
    1. Bousfiha AA, Jeddane L, El Hafidi N, Benajiba N, Rada N, El Bakkouri J, et al. . First report on the Moroccan registry of primary immunodeficiencies: 15 years of experience (1998-2012). J Clin Immunol. (2014) 34:459–68. 10.1007/s10875-014-0005-8 - DOI - PubMed
    1. Shillitoe B, Bangs C, Guzman D, Gennery AR, Longhurst HJ, Slatter M, et al. . The United Kingdom Primary Immune Deficiency (UKPID) registry 2012 to 2017. Clin Exp Immunol. (2018) 192:284–91. 10.1111/cei.13125 - DOI - PMC - PubMed
    1. Ehlayel MS, Bener A, Laban MA. Primary immunodeficiency diseases in children: 15 year experience in a tertiary care medical center in Qatar. J Clin Immunol. (2013) 33:317–24. 10.1007/s10875-012-9812-y - DOI - PubMed
    1. Abolhassani H, Kiaee F, Tavakol M, Chavoshzadeh Z, Mahdaviani SA, Momen T, et al. . Fourth update on the iranian national registry of primary immunodeficiencies: Integration of molecular diagnosis. J Clin Immunol. (2018) 38:816–32. 10.1007/s10875-018-0556-1 - DOI - PubMed
    1. Mayor PC, Eng KH, Singel KL, Abrams SI, Odunsi K, Moysich KB, et al. . Cancer in primary immunodeficiency diseases: Cancer incidence in the United States Immune Deficiency Network Registry. J Allergy Clin Immunol. (2018) 141:1028–35. 10.1016/j.jaci.2017.05.024 - DOI - PMC - PubMed
    1. Ruffner MA, USIDNET Body Weight Group. Sullivan KE. Complications associated with underweight primary immunodeficiency patients: prevalence and associations within the USIDNET registry. J Clin Immunol. (2018) 38:283–93. 10.1007/s10875-018-0492-0 - DOI - PMC - PubMed
    1. Al-Herz W, Notarangelo LD, Sadek A, Buckley R. Combined immunodeficiency in the United States and Kuwait: Comparison of patients' characteristics and molecular diagnosis. Clin Immunol. (2015) 161:170–3. 10.1016/j.clim.2015.07.013 - DOI - PMC - PubMed
    1. Al-Herz W, Moussa MA. Survival and predictors of death among primary immunodeficient patients: a registry-based study. J Clin Immunol. (2012) 32:467–73. 10.1007/s10875-011-9636-1 - DOI - PubMed
    1. Al-Herz W, Chou J, Delmonte OM, Massaad MJ, Bainter W, Castagnoli R, et al. . Comprehensive genetic results for primary immunodeficiency disorders in a highly consanguineous population. Front Immunol. (2018) 9:3146. 10.3389/fimmu.2018.03146 - DOI - PMC - PubMed
    1. Yazdani R, Abolhassani H, Kiaee F, Habibi S, Azizi G, Tavakol M, et al. . Comparison of common monogenic defects in a large predominantly antibody deficiency cohort. J Allergy Clin Immunol Pract. (2019) 7:864–78.e9. 10.1016/j.jaip.2018.09.004 - DOI - PubMed
    1. Al-Herz W. Primary immunodeficiency disorders in Kuwait: first report from Kuwait National Primary Immunodeficiency Registry (2004–2006). J Clin Immunol. (2008) 28:186–93. 10.1007/s10875-007-9144-5 - DOI - PMC - PubMed
    1. Al-Herz W, Ragupathy R, Massaad MJ, Al-Attiyah R, Nanda A, Engelhardt KR, et al. . Clinical, immunologic and genetic profiles of DOCK8-deficient patients in Kuwait. Clin Immunol. (2012) 143:266–72. 10.1016/j.clim.2012.03.002 - DOI - PMC - PubMed
    1. Ludviksson BR, Sigurdardottir ST, Johannsson JH, Haraldsson A, Hardarson TO. Epidemiology of Primary Immunodeficiency in Iceland. J Clin Immunol. (2015) 35:75–9. 10.1007/s10875-014-0107-3 - DOI - PubMed