Combined immunodeficiency due to CRAC channel dysfunction

What it is

From: Orphanet

Combined immunodeficiency (CID) due to Ca2+ release activated Ca2+(CRAC) channel dysfunction is a form of CID characterized by recurrent infections, autoimmunity, congenital myopathy and ectodermal dysplasia. It comprises two sub-types that are due to mutations in the ORAI1 and STIM1 genes: CID due to ORAI1 deficiency and CID due to STIM1 deficiency.

Reported clinical features and what the terms mean

The following findings are associated with this condition in Orphanet. They are not a checklist for diagnosing yourself, and they do not all occur in every affected person. Some are examination, imaging or laboratory findings that cannot be recognised at home.

The frequency labels describe how often a finding was reported among people with the condition in the source. They do not give the chance that a person with that symptom has the condition. Definitions below reproduce HPO terminology; they explain the term, not the likely severity in an individual.

Amelogenesis imperfecta · Very frequent (99-80%)

A developmental dysplasia of the dental enamel.

Autoimmunity · Very frequent (99-80%)

The occurrence of an immune reaction against the organism's own cells or tissues.

Chronic otitis media · Very frequent (99-80%)

Chronic otitis media refers to fluid, swelling, or infection of the middle ear that does not heal and may cause permanent damage to the ear.

Fever · Very frequent (99-80%)

Body temperature elevated above the normal range.

Hypocalcification of dental enamel · Very frequent (99-80%)

A form of hypomineralization of enamel characterized by reduced calcification.

Hypoplasia of the iris · Very frequent (99-80%)

Congenital underdevelopment of the iris.

Hypotonia · Very frequent (99-80%)

Hypotonia is an abnormally low muscle tone (the amount of tension or resistance to movement in a muscle). Even when relaxed, muscles have a continuous and passive partial contraction which provides some resistance to passive stretching. Hypotonia thus manifests as diminished resistance to passive stretching. Hypotonia is not the same as muscle weakness, although the two conditions can co-exist.

Immunodeficiency · Very frequent (99-80%)

Failure of the immune system to protect the body adequately from infection, due to the absence or insufficiency of some component process or substance.

Meningitis · Very frequent (99-80%)

Inflammation of the meninges.

Myopathy · Very frequent (99-80%)

A disorder of muscle unrelated to impairment of innervation or neuromuscular junction.

Pneumonia · Very frequent (99-80%)

Inflammation of any part of the lung parenchyma.

Recurrent bacterial infections · Very frequent (99-80%)

Increased susceptibility to bacterial infections as manifested by recurrent episodes of bacterial infection.

Recurrent fungal infections · Very frequent (99-80%)

Increased susceptibility to fungal infections as manifested by multiple episodes of fungal infection.

Recurrent mycobacterial infections · Very frequent (99-80%)

Increased susceptibility to mycobacterial infections as manifested by recurrent episodes of mycobacterial infection.

Other findings in the same source

From: Orphanet

Additional reported features include Recurrent viral infections (Very frequent (99-80%)); Sepsis (Very frequent (99-80%)); Anhidrosis (Frequent (79-30%)); Hepatomegaly (Frequent (79-30%)); Lymphadenopathy (Frequent (79-30%)); Splenomegaly (Frequent (79-30%)); Hemolytic anemia (Occasional (29-5%)); Neoplasm (Occasional (29-5%)); Thrombocytopenia (Occasional (29-5%)). This is a selected summary, not a complete description of the condition.

When it may begin

From: Orphanet

Infancy; Neonatal

Inheritance in the source

From: Orphanet

Autosomal recessive

Frequency and the population described

From: Orphanet

Reported case(s): 10.0; Worldwide. This is a published case count, not prevalence. Point prevalence: <1 / 1 000 000; Worldwide; Class only.

Understanding the inheritance label

From: MedlinePlus Genetics

An autosomal recessive pattern usually involves disease-causing changes in both copies of a gene. Parents may each carry one altered copy without having the condition themselves. A genetic counsellor can explain carrier testing and reproductive implications using the actual laboratory findings, rather than the condition name alone.

Which doctor should you see?

The suggested department for discussing Combined immunodeficiency due to CRAC channel dysfunction is Allergy and Immunology, with a allergist / clinical immunologist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Does the history suggest an allergy, an immune problem or another explanation?
• How would any proposed allergy or immune test change care?
• Is an individual emergency plan needed, and who should understand it?

Treatment discussions and follow-up

The material gathered for this draft does not provide a complete condition-specific treatment pathway for Combined immunodeficiency due to CRAC channel dysfunction. That gap does not mean that treatment is unavailable. A clinician needs to establish the diagnosis and review current guidance before recommending medicines, procedures, rehabilitation or other support.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.