X-linked agammaglobulinemia (XLA) is a condition that affects the immune system and occurs almost exclusively in males. 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 one or two 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. The most common bacterial infections that occur in people with XLA are ear infections (otitis), pneumonia, pink eye (conjunctivitis), and sinus infections (sinusitis). Infections that cause chronic diarrhea are also common. People with XLA can develop severe, life-threatening bacterial infections; however, they are not particularly vulnerable to infections caused by viruses. With treatment, infections can usually be prevented, improving the quality of life for people with XLA.
XLA occurs in approximately 1 in 200,000 newborns.
Mutations in the BTK gene cause XLA. This gene provides instructions for making the BTK protein, which is important for the development of B cells and normal functioning of the immune system. Most mutations in the BTK gene prevent the production of any BTK protein. The absence of functional BTK protein blocks B cell development and leads to a lack of antibodies. Without antibodies, the immune system cannot properly respond to foreign invaders and prevent infection.
Read more about the BTK gene.
This condition is inherited in an X-linked recessive pattern. The gene associated with this condition is located on the X chromosome, which is one of the two sex chromosomes. In males (who have only one X chromosome), one altered copy of the gene in each cell is sufficient to cause the condition. In females (who have two X chromosomes), a mutation would have to occur in both copies of the gene to cause the disorder. Because it is unlikely that females will have two altered copies of this gene, males are affected by X-linked recessive disorders much more frequently than females. A striking characteristic of X-linked inheritance is that fathers cannot pass X-linked traits to their sons.
About half of affected individuals do not have a family history of XLA. In most of these cases, the affected person's mother is a carrier of one altered BTK gene. Carriers do not have the immune system abnormalities associated with XLA, but they can pass the altered gene to their children. In other cases, the mother is not a carrier and the affected individual has a new mutation in the BTK gene.
These resources address the management of X-linked agammaglobulinemia and may include treatment providers.
You might also find information on treatment of X-linked agammaglobulinemia in
Educational resources and Patient support.
You may find the following resources about X-linked agammaglobulinemia helpful. These materials are written for the general public.
You may also be interested in these resources, which are designed for healthcare professionals and researchers.
- Bruton's agammaglobulinemia
- Congenital agammaglobulinemia
The resources on this site should not be used as a substitute for
professional medical care or advice. Users seeking information about
a personal genetic disease, syndrome, or condition should consult with a qualified
See How can I find a genetics professional in my area? in the Handbook.