Looking beyond labels: understanding the connection between Primary and Secondary Immunodeficiencies

In immunology, definitions matter. But for patients, what matters even more is understanding what lies behind them. Primary and Secondary Immunodeficiencies are often described as distinct conditions, yet in clinical practice their relationship may be far less clear-cut. According to Dr. Silvia Sánchez-Ramón, this is precisely where a broader clinical perspective becomes essential: not only to improve diagnosis, but also to better guide treatment and long-term care.

One of the key challenges is that a Secondary Immunodeficiency may sometimes reveal an underlying Primary Immunodeficiency that had previously gone unnoticed. In these cases, what first appears to be a consequence of treatment may instead point to a pre-existing immune vulnerability. This makes clinical interpretation more complex, but also more meaningful, because identifying the root cause can change the entire care pathway for a patient.

The reverse can also happen. A Primary Immunodeficiency may predispose a person to other serious conditions, such as autoimmune diseases or cancer, which then require immunosuppressive therapies that further weaken the immune system. Rather than a linear process, what emerges is an ongoing interaction, where causes and consequences may overlap and where understanding the full picture becomes crucial.

This evolving view has direct implications for diagnosis and care. While the immunological workup may in part be shared between Primary and Secondary Immunodeficiencies, suspected primary forms require genetic and functional studies. In the era of immune-targeted therapies, recognizing the specific nature of an immune defect can help clinicians make more informed treatment decisions.

The distinction remains essential because the consequences for patients are different. A Secondary Immunodeficiency may improve, or even resolve, if the underlying cause can be removed. A Primary Immunodeficiency, by contrast, may require lifelong management and, in some cases, family evaluation and genetic counseling.

Looking ahead, Dr. Sánchez-Ramón points to the growing importance of precision medicine. Genetics, epigenetics, lifestyle, and functional testing are contributing to a more individualized understanding of immune disorders. In particular, pre-treatment genetic screening may help identify a Primary Immunodeficiency before immunosuppressive or anti-cancer therapies bring it to light more clearly, allowing for safer and more informed care from the start.

Progress also depends on what comes next. Research is advancing in areas such as risk biomarkers, inflammatory and neoplastic conditions, and the therapeutic potential of epigenetics, especially where some mechanisms may prove reversible. At the same time, the field still needs stronger standardization, continued regulatory progress, and well-designed clinical trials able to translate innovation into real benefit for patients.

Awareness remains another essential priority. Dr. Sánchez-Ramón highlights the need for greater education across medical specialties caring for patients with severe conditions, including hematological cancers and systemic autoimmune diseases. Public awareness matters too, because informed patients can help bring attention to possibilities that might otherwise remain overlooked. In a field where timing can shape outcomes, awareness is part of care.

At the center of this perspective is a simple but important shift: moving beyond rigid categories toward a more patient-centered understanding of immune dysfunction. The better clinicians can recognize the interplay between Primary and Secondary Immunodeficiencies, the better equipped they are to reduce uncertainty, personalize treatment, and improve the care journey.

During World PI Week 2026, Kedrion reaffirmed its commitment to advancing knowledge and fostering collaboration with the medical and scientific community. By supporting a deeper understanding of immunodeficiencies, and the interplay between Primary and Secondary forms, we aim to help promote timely, informed, and person-centered care.