51
|
Eddens T, Mack M, McCormick M, Chong H, Kalpatthi R. Trends in Pediatric Primary Immunodeficiency: Incidence, Utilization, Transplantation, and Mortality. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:286-296.e3. [PMID: 34718217 PMCID: PMC8961698 DOI: 10.1016/j.jaip.2021.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/01/2021] [Accepted: 10/14/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Primary immunodeficiency disorders (PIDDs) describe a myriad of diseases caused by inherited defects within the immune system. As the number of identified genetic defects associated with PIDDs increases, understanding the incidence and outcomes of PIDD patients becomes imperative. OBJECTIVE To characterize the frequency of new diagnoses, patterns of health care utilization, rates of hematopoietic stem cell transplantation (HSCT), and mortality in pediatric patients with PIDDs. METHODS A retrospective cohort analysis of the Pediatric Health Information System database from 2004 to 2018 for pediatric inpatients with an International Classification of Diseases, Ninth and 10th Revisions (ICD-9/ICD-10). code associated with PIDD. RESULTS A total of 17,234 patients with a PIDD were hospitalized from 2004 to 2018. There were 2.8 new PIDD diagnoses and 6.3 PIDD hospitalizations per 1,000 discharges; these metrics were unchanged during the study period. The number of new diagnoses for B-cell and antibody defects significantly increased over time. The number of new PIDD diagnoses significantly increased in adolescents or adults and decreased in infants. T-cell disorders had the highest number of intensive care unit admissions. There were 747 PIDD patients who underwent HSCT; complications of HSCT significantly decreased over time. Mortality rates significantly decreased in all PIDD patients and in patients receiving HSCT. CONCLUSIONS The total hospitalizations and incidence of PIDDs within the hospitalized pediatric population were unchanged. There were significant changes in the class of PIDD diagnosed, the age at diagnosis, and health care utilization metrics. Mortality significantly decreased over time within the PIDD cohort.
Collapse
Affiliation(s)
- Taylor Eddens
- Pediatric Scientist Development Program, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pa,Department of Allergy and Immunology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pa
| | - Molly Mack
- Pediatric Residency Program, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pa
| | - Meghan McCormick
- Department of Hematology and Oncology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pa
| | - Hey Chong
- Department of Allergy and Immunology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pa
| | | |
Collapse
|
52
|
Health-related quality of life in primary immunodeficiencies: Impact of delayed diagnosis and treatment burden. Clin Immunol 2022; 236:108931. [DOI: 10.1016/j.clim.2022.108931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/13/2022] [Indexed: 12/28/2022]
|
53
|
Santamaria M, Neth O, Douglass JA, Krivan G, Kobbe R, Bernatowska E, Grigoriadou S, Bethune C, Chandra A, Horneff G, Borte M, Sonnenschein A, Kralickova P, Ramón SS, Langguth D, Gonzalez-Granado LI, Alsina L, Querolt M, Griffin R, Hames C, Mondou E, Price J, Sanz A, Lin J. A Multi‑Center, Open‑Label, Single‑Arm Trial to Evaluate the Efficacy, Pharmacokinetics, and Safety and Tolerability of IGSC 20% in Subjects with Primary Immunodeficiency. J Clin Immunol 2022; 42:500-511. [PMID: 34973143 PMCID: PMC9016006 DOI: 10.1007/s10875-021-01181-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Abstract
Purpose The purpose of this phase 3 study was to evaluate the efficacy, pharmacokinetics (PK), and safety of Immune Globulin Subcutaneous (Human), 20% Caprylate/Chromatography Purified (IGSC 20%) in patients with primary immunodeficiency (PI). Methods Immunoglobulin treatment-experienced subjects with PI received 52 weeks of IGSC 20% given weekly at the same dose as the subject’s previous IgG regimen (DAF 1:1); the minimum dose was 100 mg/kg/week. The primary endpoint was serious bacterial infections (SBIs [null vs alternative hypothesis: SBI rate per person per year ≥ 1 vs < 1]). IgG subclasses and specific pathogen antibody levels were also measured. Results Sixty-one subjects (19 children [≤ 12 years], 10 adolescents [> 12–16 years], and 32 adults) were enrolled. The rate of SBIs per person per year was 0.017. The 1-sided 99% upper confidence limit was 0.036 (< 1), and the null hypothesis was rejected. The rate of hospitalization due to infection per person per year was 0.017 (2-sided 95% confidence interval: 0.008–0.033) overall. The mean trough total IgG concentrations were comparable to the previous IgG replacement regimen. The average of the individual mean trough ratios (IGSC 20%:previous regimen) was 1.078 (range: 0.83–1.54). The average steady-state mean trough IgG concentrations were 947.64 and 891.37 mg/dL, respectively. Seven subjects had serious treatment-emergent adverse events (TEAEs); none was drug-related. The rate of all TEAEs, including local infusion site reactions, during 3045 IGSC 20% infusions was 0.135. Most TEAEs were mild or moderate. Conclusions IGSC 20% demonstrated efficacy and good safety and tolerability in subjects with PI. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-021-01181-6.
Collapse
Affiliation(s)
- Manuel Santamaria
- Unidad de Inmunologia Clinica, Hospital Universitario Reina Sofía, Facultad de Medicina, Universidad de Cordoba, Cordoba, Spain
| | - Olaf Neth
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica RITIP, IBiSSeville, Spain
| | - Jo A Douglass
- Department of Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Gergely Krivan
- Paediatric Haematology and Hemopoietic Stem Cell Transplantation Department, Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Robin Kobbe
- First Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ewa Bernatowska
- Department of Immunology, Children's Memorial Health Institute, Warsaw, Poland
| | - Sofia Grigoriadou
- Department of Immunology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Claire Bethune
- Peninsula Immunology and Allergy Service, University Hospitals Plymouth, Plymouth, UK
| | - Anita Chandra
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Gerd Horneff
- Asklepios Kinderklinik Sankt Augustin, Sankt Augustin, Germany.,University Hospital of Cologne, Cologne, Germany
| | - Michael Borte
- Klinikum St Georg GmbH, Klinik für Kinder- und Jugendmedizin, Leipzig, Germany
| | - Anja Sonnenschein
- Department of Pediatric Immunology and Rheumatology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Pavlina Kralickova
- Department of Allergology and Clinical Immunology, Faculty of Medicine, Charles University and University Hospital in Hradec Kralove, Hradec Kralove, Czechia
| | | | - Daman Langguth
- Immunology Department, Sullivan Nicolaides Pathology, Brisbane, Australia
| | - Luis Ignacio Gonzalez-Granado
- Primary Immunodeficiencies Unit, Hospital Universitario 12 de Octubre and Department of Public and Maternal - Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Laia Alsina
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain. .,Institut de Recerca Sant Joan de Déu, Barcelona, Spain. .,Universitat de Barcelona, Barcelona, Spain.
| | - Montse Querolt
- Grifols Bioscience Research Group, Sant Cugat del Vallès, Barcelona, Spain
| | - Rhonda Griffin
- Grifols Bioscience Research Group, NC, Research Triangle Park, USA
| | - Carrie Hames
- Grifols Bioscience Research Group, NC, Research Triangle Park, USA
| | - Elsa Mondou
- Grifols Bioscience Research Group, NC, Research Triangle Park, USA
| | - Jeffrey Price
- Grifols Bioscience Research Group, NC, Research Triangle Park, USA
| | - Ana Sanz
- Grifols Bioscience Research Group, Sant Cugat del Vallès, Barcelona, Spain
| | - Jiang Lin
- Grifols Bioscience Research Group, NC, Research Triangle Park, USA
| |
Collapse
|
54
|
Nordin J, Solís L, Prévot J, Mahlaoui N, Chapel H, Sánchez-Ramón S, Ali A, Seymour JW, Pergent M. The PID Principles of Care: Where Are We Now? A Global Status Report Based on the PID Life Index. Front Immunol 2021; 12:780140. [PMID: 34868053 PMCID: PMC8637458 DOI: 10.3389/fimmu.2021.780140] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
A global gold standard framework for primary immunodeficiency (PID) care, structured around six principles, was published in 2014. To measure the implementation status of these principles IPOPI developed the PID Life Index in 2020, an interactive tool aggregating national PID data. This development was combined with a revision of the principles to consider advances in the field of health and science as well as political developments since 2014. The revision resulted in the following six principles: PID diagnosis, treatments, universal health coverage, specialised centres, national patient organisations and registries for PIDs. A questionnaire corresponding to these principles was sent out to IPOPI’s national member organisations and to countries in which IPOPI had medical contacts, and data was gathered from 60 countries. The data demonstrates that, regardless of global scientific progress on PIDs with a growing number of diagnostic tools and better treatment options becoming available, the accessibility and affordability of these remains uneven throughout the world. It is not only visible between regions, but also between countries within the same region. One of the most urgent needs is medical education. In countries without immunologists, patients with PID suffer the risk of remaining undiagnosed or misdiagnosed, resulting in health implications or even death. Many countries also lack the infrastructure needed to carry out more advanced diagnostic tests and perform treatments such as hematopoietic stem cell transplantation or gene therapy. The incapacity to secure appropriate diagnosis and treatments affects the PID environment negatively in these countries. Availability and affordability also remain key issues, as diagnosis and treatments require coverage/reimbursement to ensure that patients with PID can access them in practice, not only in theory. This is still not the case in many countries of the world according to the PID Life Index. Although some countries do perform better than others, to date no country has fully implemented the PID principles of care, confirming the long way ahead to ensure an optimal environment for patients with PID in every country.
Collapse
Affiliation(s)
- Julia Nordin
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, United Kingdom
| | - Leire Solís
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, United Kingdom
| | - Johan Prévot
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, United Kingdom
| | - Nizar Mahlaoui
- Pediatric Immunology-Hematology and Rheumatology Unit, Necker Children's University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Children's University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Helen Chapel
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Silvia Sánchez-Ramón
- Department of Clinical Immunology, Instituto de Medicina del Laboratorio (IML) and Instituto de Investigación Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain.,Department of Immunology, ENT and Ophthalmology, Complutense University School of Medicine, Madrid, Spain
| | - Adli Ali
- Clinical Immunology Unit, Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Institute of IR4.0, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - John W Seymour
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, United Kingdom.,Department of Counseling and Student Personnel, Minnesota State University, Mankato, MN, United States
| | - Martine Pergent
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, United Kingdom
| |
Collapse
|
55
|
Godsell J, Chan S, Slade C, Bryant V, Douglass JA, Sasadeusz J, Yong MK. Cytomegalovirus in primary immunodeficiency. Curr Opin Infect Dis 2021; 34:663-671. [PMID: 34608876 DOI: 10.1097/qco.0000000000000797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Cytomegalovirus (CMV) infection and disease are well described in the setting of secondary immunodeficiency. Less is known about CMV in the context of primary immunodeficiencies (PIDs), where inborn errors in one or more arms of the immune system result in variable degrees of CMV susceptibility. RECENT FINDINGS PID presents unique challenges in the diagnosis and management of CMV disease. The clinical presentation of CMV in PID is often severe, accelerated by underlying immune dysregulation and iatrogenic immunosuppression. Here we describe the clinical significance of CMV infection in PID, the key components of immune defence against CMV and how these are affected in specific PIDs. CMV disease is under-recognized as a complication of common variable immunodeficiency (CVID). High rates of CMV end-organ disease, mortality, development of CMV resistance and prolonged antiviral use have been observed in individuals with CVID. SUMMARY We recommend that clinicians tailor their approach to the individual based on their underlying immune deficit and maintain a high index of suspicion and low threshold for treatment. More research is required to improve stratification of CMV risk in PID, develop new diagnostic tools and manage end-organ disease in this cohort.
Collapse
Affiliation(s)
- Jack Godsell
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital
| | - Samantha Chan
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital
- Immunology Division, Walter & Eliza Hall Institute of Medical Research
- Department of Medicine, University of Melbourne
| | - Charlotte Slade
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital
- Immunology Division, Walter & Eliza Hall Institute of Medical Research
| | - Vanessa Bryant
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital
- Immunology Division, Walter & Eliza Hall Institute of Medical Research
| | - Jo Anne Douglass
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital
- Department of Medicine, University of Melbourne
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne
| | - Michelle K Yong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
56
|
Hosaka S, Kido T, Imagawa K, Fukushima H, Morio T, Nonoyama S, Takada H. Vaccination for Patients with Inborn Errors of Immunity: a Nationwide Survey in Japan. J Clin Immunol 2021; 42:183-194. [PMID: 34704141 DOI: 10.1007/s10875-021-01160-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/11/2021] [Indexed: 01/23/2023]
Abstract
We conducted a nationwide survey of inborn errors of immunity (IEI) in Japan for the second time in 10 years, focusing on protective measures for IEI patients against infectious diseases. Questionnaires were sent to various medical departments nationwide, and a total of 1307 patients were reported. The prevalence of IEI was 2.2 patients per 100,000 population, which was comparable with the previous nationwide study. The most common disease category was autoinflammatory disorders (25%), followed by antibody deficiencies (24%) and congenital defects of phagocyte number or function (16%). We found that a significant number of patients received contraindicated vaccines, principally because the patients were not diagnosed with IEI by the time of the vaccination. Regarding diseases for which BCG vaccination is contraindicated, 43% of patients had actually received BCG, of which 14% developed BCG-related infections. BCG-related infections were mainly observed among patients with CGD and MSMD. In order to prevent IEI patients from receiving inadequate vaccines, continuous education to parents and physicians is needed, along with the expansion of newborn screening, but efforts to screen IEI at the site of vaccination also remain important.
Collapse
Affiliation(s)
- Sho Hosaka
- Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan.
| | - Takahiro Kido
- Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kazuo Imagawa
- Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan.,Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroko Fukushima
- Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan.,Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tomohiro Morio
- Department of Pediatrics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Shigeaki Nonoyama
- Department of Pediatrics, National Defense Medical College, Saitama, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan.,Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| |
Collapse
|
57
|
Al-Herz W, Zainal M, Nanda A. A Prospective Survey of Skin Manifestations in Children With Inborn Errors of Immunity From a National Registry Over 17 Years. Front Immunol 2021; 12:751469. [PMID: 34659256 PMCID: PMC8514786 DOI: 10.3389/fimmu.2021.751469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Reports on skin manifestations in inborn errors of immunity (IEI) are based on retrospective analysis, small series, or isolated case reports. The present prospective study aimed to determine the spectrum of skin manifestations in children with IEI and their relevance to specific molecular defects. Materials and Methods The data were obtained from the Kuwait National Primary Immunodeficiency Disorders Registry during the period of 2004–2020. Results A total of 313 pediatric cases of IEI, 71% diagnosed at molecular level, were registered with a cumulative follow-up period of 29,734 months. Skin manifestations were seen in 40.3% of the patients, and they were among the presenting manifestations in 33%. Patients with skin manifestations were older at both onset and diagnosis ages of IEI symptoms, but this was statistically significant for the latter only. The diagnosis delay was significantly longer in patients with skin manifestations. There was a statistically significant association between having skin manifestations and IEI category, being more common in patients with complement deficiencies, combined immunodeficiencies, and diseases of immune dysregulation. There was no statistically significant association between having skin manifestations and both gender and survival. Skin infections were the most frequent manifestations followed by eczema and autoimmune associations. Among IEI with more than 10 cases, skin lesions were a consistent finding in dedicator of cytokinesis 8 (DOCK8) deficiency, hyper IgE syndrome, ataxia-telangiectasia, and recombination activation gene (RAG)1 deficiency. Conclusions Skin manifestations are common in IEI patients, and they had significant diagnosis delay and referral to specialists. Improvement of awareness about IEI is needed among pediatricians and dermatologists.
Collapse
Affiliation(s)
- Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.,Allergy and Clinical Immunology Unit, Pediatric Department, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Mohammad Zainal
- Department of Quantitative Methods and Information Systems, College of Business Administration, Kuwait University, Kuwait City, Kuwait
| | - Arti Nanda
- As'ad Al-Hamad Dermatology Center, Kuwait City, Kuwait
| |
Collapse
|
58
|
Condino-Neto A, Sullivan KE. The relevance of primary immunodeficiency registries on a global perspective. J Allergy Clin Immunol 2021; 148:1170-1171. [PMID: 34536417 DOI: 10.1016/j.jaci.2021.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
| | - Kathleen E Sullivan
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| |
Collapse
|
59
|
Piza CFSDT, Aranda CS, Solé D, Jolles S, Condino-Neto A. Serum Protein Electrophoresis May Be Used as a Screening Tool for Antibody Deficiency in Children and Adolescents. Front Immunol 2021; 12:712637. [PMID: 34497609 PMCID: PMC8419225 DOI: 10.3389/fimmu.2021.712637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients with antibody deficiency may experience exceptionally long diagnostic delays, increasing the risk of life-threatening infections, end-organ damage, mortality, and health costs. Objective This study aimed to analyze serum protein electrophoresis and verify the correlation between calculated globulin (CG, total protein minus albumin levels) or electrophoretically determined serum gamma globulin fraction (Gamma) with IgG levels in children and adolescents under 18 years old (yo). Methods We analyzed serum protein electrophoresis (GC or Gamma) and IgG levels from 1215 children and adolescents under 18 yo, classified into 5 age groups. We verified the correlation between CG or Gamma with serum IgG levels. Results Serum IgG levels varied according to age groups (from 4.3 ± 2.3 g/l in children under 6 months old to 11.4 ± 3.2 g/l in adolescents in the 10-<18 yo group). CG sensitivity and specificity to detect IgG below the reference range for all patients were 93.1% and 81.8%, respectively, and varied according to age group. Gamma sensitivity and specificity for all patients were 100% and 87.8%, respectively, and varied according to age group as well. We found serum IgG levels below the age reference level in 29 patients (2.4% of the cases) using CG or Gamma levels. Conclusion Both CG and Gamma levels may be of utility as a screening tool for earlier diagnosis of antibody deficiency in children and adolescents under 18 yo.
Collapse
Affiliation(s)
| | - Carolina Sanchez Aranda
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Dirceu Solé
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
| | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
60
|
Frazer-Abel A, Kirschfink M, Prohászka Z. Expanding Horizons in Complement Analysis and Quality Control. Front Immunol 2021; 12:697313. [PMID: 34434189 PMCID: PMC8381195 DOI: 10.3389/fimmu.2021.697313] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/19/2021] [Indexed: 01/09/2023] Open
Abstract
Complement not only plays a key role in host microbial defense but also modulates the adaptive immune response through modification of T- and B-cell reactivity. Moreover, a normally functioning complement system participates in hematopoiesis, reproduction, lipid metabolism, and tissue regeneration. Because of its powerful inflammatory potential, multiple regulatory proteins are needed to prevent potential tissue damage. In clinical practice, dysregulation and overactivation of the complement system are major causes of a variety of inflammatory and autoimmune diseases ranging from nephropathies, age-related macular degeneration (AMD), and systemic lupus erythematosus (SLE) to graft rejection, sepsis, and multi-organ failure. The clinical importance is reflected by the recent development of multiple drugs targeting complement with a broad spectrum of indications. The recognition of the role of complement in diverse diseases and the advent of complement therapeutics has increased the number of laboratories and suppliers entering the field. This has highlighted the need for reliable complement testing. The relatively rapid expansion in complement testing has presented challenges for a previously niche field. This is exemplified by the issue of cross-reactivity of complement-directed antibodies and by the challenges of the poor stability of many of the complement analytes. The complex nature of complement testing and increasing clinical demand has been met in the last decade by efforts to improve the standardization among laboratories. Initiated by the IUIS/ICS Committee for the Standardization and Quality Assessment in Complement Measurements 14 rounds of external quality assessment since 2010 resulted in improvements in the consistency of testing across participating institutions, while extending the global reach of the efforts to more than 200 laboratories in 30 countries. Worldwide trends of assay availability, usage, and analytical performance are summarized based on the past years’ experiences. Progress in complement analysis has been facilitated by the quality assessment and standardization efforts that now allow complement testing to provide a comprehensive insight into deficiencies and the activation state of the system. This in turn enables clinicians to better define disease severity, evolution, and response to therapy.
Collapse
Affiliation(s)
| | | | - Zoltán Prohászka
- Department of Medicine and Hematology, Research Laboratory Semmelweis University, Budapest, Hungary
| |
Collapse
|
61
|
Esmaeilzadeh H, Askarisarvestani A, Hosseini N, Samimi S, Shafiei A, Mahdaviani SA, Eslami N, Chavoshzadeh Z, Fallahi M, Khakbazanfard N, Shabestari MS, Aleyasin S, Nabavizadeh SH, Cheraghi T, Kalantari A, Ahmadiafshar A, Safari M, Eslamian MH, Molatefi R, Shirkani A, Heidarzadeh Arani M, Tavakol M, Bemanian MH, Arshi S, Nabavi M, Shokri S, Shahhosseini B, Mortazavi N, Nakhaei P, Nazari F, Fallahpour M, Ahanchian H, Moazzen N, Khoshkhui M, Motlagh AV, Aghamohammadi A, Abolhassani H, Yazdani R, Rezaei N. Adverse reactions in a large cohort of patients with inborn errors of immunity receiving intravenous immunoglobulin. Clin Immunol 2021; 230:108826. [PMID: 34418548 DOI: 10.1016/j.clim.2021.108826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/07/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intravenous immunoglobulins (IVIg) are the major treatment in inborn errors of immunity (IEI) disorders; However, IVIg infusions show some adverse effects. We aimed to assess the adverse reactions of IVIg infusions. METHODS Data of IVIg infusions in IEI patients were collected from 2011 to 2021. Totally, 363 IEI patients received IVIg regularly in Iran entered the study. The adverse reactions are classified regarding their severity and chronicity. RESULTS 22,667 IVIg infusions were performed in the study. 157 patients (43.2%) and 1349 (5.9%) infusions were associated with at least one type of adverse reaction. The highest rates of adverse reactions were seen in severe combined immunodeficiency. Myalgia, chills, headache, fever, and hypotension were the most frequent adverse effects of IVIg. CONCLUSION The reactions affect almost half of the patients mainly in the first infusions which necessitate the close observation of IEI patients receiving IVIg.
Collapse
Affiliation(s)
- Hossein Esmaeilzadeh
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Division of Allergy and Clinical Immunology, Pediatrics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Askarisarvestani
- Division of Allergy and Clinical Immunology, Pediatrics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Hosseini
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Samimi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Alireza Shafiei
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Eslami
- Allergy and Clinical immunology Dept, Mofid Children Hospital, , Shahid Beheshti University of Medical Sciences, Tehran, , Iran
| | - Zahra Chavoshzadeh
- Allergy and Clinical immunology Dept, Mofid Children Hospital, , Shahid Beheshti University of Medical Sciences, Tehran, , Iran
| | - Mazdak Fallahi
- Allergy and Clinical immunology Dept, Mofid Children Hospital, , Shahid Beheshti University of Medical Sciences, Tehran, , Iran
| | - Nasrin Khakbazanfard
- Allergy and Clinical immunology Dept, Mofid Children Hospital, , Shahid Beheshti University of Medical Sciences, Tehran, , Iran
| | | | - Soheila Aleyasin
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Division of Allergy and Clinical Immunology, Pediatrics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hesamedin Nabavizadeh
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Division of Allergy and Clinical Immunology, Pediatrics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Taher Cheraghi
- Department of Pediatrics, 17th Shahrivar Children's Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Arash Kalantari
- Department of Immunology and Allergy, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mojgan Safari
- Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Rasol Molatefi
- Department of Pediatrics, Bo-Ali children's Hospital of Ardabil University of Medical Sciences, Ardabil, Iran
| | - Afshin Shirkani
- Allergy and Clinical Immunology Department, Bushehr University of Medical Science, School of Medicine, Bushehr, Iran
| | | | - Marzieh Tavakol
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Hassan Bemanian
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Arshi
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nabavi
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sima Shokri
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Shahhosseini
- Division of Allergy and Clinical Immunology, Pediatrics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Mortazavi
- Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooria Nakhaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Nazari
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Morteza Fallahpour
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Ahanchian
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasrin Moazzen
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Vosughi Motlagh
- Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd. Iran
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Division of Clinical Immunology, Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden; Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| |
Collapse
|
62
|
Azizi G, Tavakol M, Yazdani R, Delavari S, Moeini Shad T, Rasouli SE, Jamee M, Pashangzadeh S, Kalantari A, Shariat M, Shafiei A, Mohammadi J, Hassanpour G, Chavoshzadeh Z, Mahdaviani SA, Momen T, Behniafard N, Nabavi M, Bemanian MH, Arshi S, Molatefi R, Sherkat R, Shirkani A, Alyasin S, Jabbari-Azad F, Ghaffari J, Mesdaghi M, Ahanchian H, Khoshkhui M, Eslamian MH, Cheraghi T, Dabbaghzadeh A, Nasiri Kalmarzi R, Esmaeilzadeh H, Tafaroji J, Khalili A, Sadeghi-Shabestari M, Darougar S, Moghtaderi M, Ahmadiafshar A, Shakerian B, Heidarzadeh M, Ghalebaghi B, Fathi SM, Darabi B, Fallahpour M, Mohsenzadeh A, Ebrahimi S, Sharafian S, Vosughimotlagh A, Tafakoridelbari M, Rahimi Haji-Abadi M, Ashournia P, Razaghian A, Rezaei A, Salami F, Shirmast P, Bazargan N, Mamishi S, Khazaei HA, Negahdari B, Shokri S, Nabavizadeh SH, Bazregari S, Ghasemi R, Bayat S, Eshaghi H, Rezaei N, Abolhassani H, Aghamohammadi A. Autoimmune manifestations among 461 patients with monogenic inborn errors of immunity. Pediatr Allergy Immunol 2021; 32:1335-1348. [PMID: 33774840 DOI: 10.1111/pai.13510] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The inborn errors of immunity (IEIs) are a group of heterogeneous disorders mainly characterized by severe and recurrent infections besides other complications including autoimmune and inflammatory diseases. In this study, we aim to evaluate clinical, immunologic, and molecular data of monogenic IEI patients with and without autoimmune manifestations. METHODS We have retrospectively screened cases of monogenic IEI in the Iranian PID registry for the occurrence of autoimmunity and immune dysregulation. A questionnaire was filled for all qualified patients with monogenic defects to evaluate demographic, laboratory, clinical, and molecular data. RESULTS A total of 461 monogenic IEI patients (290 male and 171 female) with a median (IQR) age of 11.0 (6.0-20.0) years were enrolled in this study. Overall, 331 patients (72.1%) were born to consanguineous parents. At the time of the study, 330 individuals (75.7%) were alive and 106 (24.3%) were deceased. Autoimmunity was reported in 92 (20.0%) patients with a median (IQR) age at autoimmune diagnosis of 4.0 (2.0-7.0) years. Sixteen patients (3.5%) showed autoimmune complications (mostly autoimmune cytopenia) as the first presentation of the disease. Most of the patients with autoimmunity were diagnosed clinically with common variable immunodeficiency (42.4%). The frequency of sinusitis and splenomegaly was significantly higher in patients with autoimmunity than patients without autoimmunity. In patients with autoimmunity, the most common pathogenic variants were identified in LRBA (in 21 patients, 23.0%), ATM (in 13 patients, 14.0%), and BTK (in 9 patients, 10.0%) genes. In the evaluation of autoimmunity by different genes, 4 of 4 IL10RB (100%), 3 of 3 AIRE (100%), and 21 of 30 LRBA (70.0%) mutated genes had the highest prevalence of autoimmunity. CONCLUSIONS Autoimmune phenomena are common features among patients with monogenic IEI and are associated with a more complicated course of the disease. Therefore, when encountering autoimmune disorders, especially in the setting of dysgammaglobulinemia, it would be appropriate to conduct next-generation sequencing to discover responsible genes for the immune dysregulation at an early stage of the disease.
Collapse
Affiliation(s)
- Gholamreza Azizi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Marzieh Tavakol
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.,Iranian Primary Immunodeficiencies Network (IPIN), Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Delavari
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Tannaz Moeini Shad
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Erfan Rasouli
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahnaz Jamee
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Salar Pashangzadeh
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Arash Kalantari
- Department of Immunology and Allergy, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Shariat
- Department of Allergy and Clinical Immunology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Shafiei
- Department of Immunology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Mohammadi
- Department of Life Science, Faculty of New Science and Technology, University of Tehran, Tehran, Iran
| | - Gholamreza Hassanpour
- Center for Research of Endemic Parasites of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Chavoshzadeh
- Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Mahdaviani
- Pediatric Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tooba Momen
- Department of Allergy and Clinical Immunology, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrin Behniafard
- Department of Allergy and Clinical Immunology, Shahid Sadoughi University of Medical Sciences, and Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Nabavi
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Bemanian
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Arshi
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Rasol Molatefi
- Department of Pediatrics, Bo-Ali Children's Hospital of Ardabil University of Medical Sciences, Ardabil, Iran
| | - Roya Sherkat
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Shirkani
- Allergy and Clinical Immunology Department, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Soheila Alyasin
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Javad Ghaffari
- Molecular and Cell Biology Research Center, Pediatric Infectious Diseases Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehrnaz Mesdaghi
- Immunology and Allergy Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Hamid Ahanchian
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Taher Cheraghi
- Department of Pediatrics, 17 Shahrivar Children's Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Dabbaghzadeh
- Pediatric Infectious Diseases Research Center, Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rasoul Nasiri Kalmarzi
- Lung Diseases and Allergy Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Javad Tafaroji
- Department of Pediatrics, Qom University of Medical Sciences, Qom, Iran
| | - Abbas Khalili
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahnaz Sadeghi-Shabestari
- Immunology Research Center of Tabriz, TB and Lung Research Center of Tabriz, Children Hospital, Tabriz University of Medical science, Tabriz, Iran
| | - Sepideh Darougar
- Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Moghtaderi
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Behzad Shakerian
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Heidarzadeh
- Department of Immunology and Allergy, Kashan University of Medical Sciences, Kashan, Iran
| | - Babak Ghalebaghi
- Department of Pediatrics, 17 Shahrivar Children's Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyed Mohammad Fathi
- Department of Immunology and Allergy, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Behzad Darabi
- Department of Immunology and Allergy, Ilam University of Medical Sciences, Ilam, Iran
| | - Morteza Fallahpour
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Azam Mohsenzadeh
- Department of Pediatrics, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Sarehsadat Ebrahimi
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Pediatrics Center of Excellences, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samin Sharafian
- Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Vosughimotlagh
- Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mitra Tafakoridelbari
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Pediatrics Center of Excellences, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziyar Rahimi Haji-Abadi
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Pediatrics Center of Excellences, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Ashournia
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Pediatrics Center of Excellences, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Razaghian
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Pediatrics Center of Excellences, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Fereshte Salami
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Paniz Shirmast
- Iranian Primary Immunodeficiencies Network (IPIN), Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Bazargan
- Department of Immunology and Allergy, Kerman University of Medical Sciences, Kerman, Iran
| | - Setareh Mamishi
- Pediatric Infectious Diseases Research Center, Tehran University of Medical, Sciences, Tehran, Iran
| | - Hossein Ali Khazaei
- Clinical Immunology Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Babak Negahdari
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Shokri
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Bazregari
- Department of Allergy and Immunology, Bandar Abbas Children's Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ramin Ghasemi
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Bayat
- Medical Genetics Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Eshaghi
- Department of Immunology and Allergy, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.,Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at the Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.,Iranian Primary Immunodeficiencies Network (IPIN), Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
63
|
Salnikova LE, Kolobkov DS, Sviridova DA, Abilev SK. An overview of germline variations in genes of primary immunodeficiences through integrative analysis of ClinVar, HGMD ® and dbSNP databases. Hum Genet 2021; 140:1379-1393. [PMID: 34272616 DOI: 10.1007/s00439-021-02316-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/10/2021] [Indexed: 12/20/2022]
Abstract
Primary immunodeficiencies (PID) are a diverse group of genetic disorders caused by inadequate development and function of immune system. Identifying genetic etiology is important for genetic counselling and treatment decisions. Clinical relevance of genetic variants is a complex problem depending on gene-specific and variant specific genotype-phenotype interactions. To address this challenge, we aimed to characterize the pathogenic landscape of PID genes by combining the analysis of germline variations reported in ClinVar and HGMD® and identification of damaging variations available in dbSNP. We generated a joint ClinVar/HGMD database, which included 111,940 variants, among them 32,452 were classified as pathogenic/likely pathogenic. From a total of 5,415,794 bi- or multiallelic variants in PID genes recorded in dbSNP, we retrieved 38,291 high impact (HI) biallelic variants with presumably disruptive impact in the protein, of them 25,500 variants were not present in ClinVar/HGMD. Using a functional prediction algorithm, we additionally identified 28,507 deleterious and 56,016 neutral missense variants among dbSNP variants and created a collection of damaging and neutral variations in PID genes, not currently present in ClinVar/HGMD, with their allele frequencies and mappings to protein domains. The distribution of pathogenic variants from ClinVar/HGMD, HI variants and deleterious missense variants from dbSNP was analyzed in the context of hereditary pattern and gene specific metrics, such as pLI and haploinsufficiency. Our report summarized data on complex gene-specific variability in PID genes and might be useful for the identification of the most promising variants and gene regions for further study.
Collapse
Affiliation(s)
- Lyubov E Salnikova
- The Laboratory of Ecological Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkin Street, Moscow, 117971, Russia. .,The Laboratory of Molecular Immunology, Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia. .,The Laboratory of Clinical Pathophysiology of Critical Conditions, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia.
| | - Dmitry S Kolobkov
- The Laboratory of Ecological Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkin Street, Moscow, 117971, Russia.,Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel.,Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Darya A Sviridova
- The Laboratory of Ecological Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkin Street, Moscow, 117971, Russia
| | - Serikbai K Abilev
- The Laboratory of Ecological Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkin Street, Moscow, 117971, Russia
| |
Collapse
|
64
|
Aghamohammadi A, Rezaei N, Yazdani R, Delavari S, Kutukculer N, Topyildiz E, Ozen A, Baris S, Karakoc-Aydiner E, Kilic SS, Kose H, Gulez N, Genel F, Reisli I, Djenouhat K, Tahiat A, Boukari R, Ladj S, Belbouab R, Ferhani Y, Belaid B, Djidjik R, Kechout N, Attal N, Saidani K, Barbouche R, Bousfiha A, Sobh A, Rizk R, Elnagdy MH, Al-Ahmed M, Al-Tamemi S, Nasrullayeva G, Adeli M, Al-Nesf M, Hassen A, Mehawej C, Irani C, Megarbane A, Quinn J, Maródi L, Modell V, Modell F, Al-Herz W, Geha RS, Abolhassani H. Consensus Middle East and North Africa Registry on Inborn Errors of Immunity. J Clin Immunol 2021; 41:1339-1351. [PMID: 34052995 PMCID: PMC8310844 DOI: 10.1007/s10875-021-01053-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023]
Abstract
Background Inborn errors of immunity (IEIs) are a heterogeneous group of genetic defects of immunity, which cause high rates of morbidity and mortality mainly among children due to infectious and non-infectious complications. The IEI burden has been critically underestimated in countries from middle- and low-income regions and the majority of patients with IEI in these regions lack a molecular diagnosis. Methods We analyzed the clinical, immunologic, and genetic data of IEI patients from 22 countries in the Middle East and North Africa (MENA) region. The data was collected from national registries and diverse databases such as the Asian Pacific Society for Immunodeficiencies (APSID) registry, African Society for Immunodeficiencies (ASID) registry, Jeffrey Modell Foundation (JMF) registry, J Project centers, and International Consortium on Immune Deficiency (ICID) centers. Results We identified 17,120 patients with IEI, among which females represented 39.4%. Parental consanguinity was present in 60.5% of cases and 27.3% of the patients were from families with a confirmed previous family history of IEI. The median age of patients at the onset of disease was 36 months and the median delay in diagnosis was 41 months. The rate of registered IEI patients ranges between 0.02 and 7.58 per 100,000 population, and the lowest rates were in countries with the highest rates of disability-adjusted life years (DALY) and death rates for children. Predominantly antibody deficiencies were the most frequent IEI entities diagnosed in 41.2% of the cohort. Among 5871 patients genetically evaluated, the diagnostic yield was 83% with the majority (65.2%) having autosomal recessive defects. The mortality rate was the highest in patients with non-syndromic combined immunodeficiency (51.7%, median age: 3.5 years) and particularly in patients with mutations in specific genes associated with this phenotype (RFXANK, RAG1, and IL2RG). Conclusions This comprehensive registry highlights the importance of a detailed investigation of IEI patients in the MENA region. The high yield of genetic diagnosis of IEI in this region has important implications for prevention, prognosis, treatment, and resource allocation. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-021-01053-z.
Collapse
Affiliation(s)
- Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Delavari
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Necil Kutukculer
- Department of Pediatric Immunology, Ege University Faculty of Medicine, Bornova-İzmir, Turkey
| | - Ezgi Topyildiz
- Department of Pediatric Immunology, Ege University Faculty of Medicine, Bornova-İzmir, Turkey
| | - Ahmet Ozen
- Faculty of Medicine, Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.,The Isil Berat Barlan Center for Translational Medicine, Istanbul Jeffrey Modell Foundation Diagnostic Center for Primary Immune Deficiencies, Istanbul, Turkey
| | - Safa Baris
- Faculty of Medicine, Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.,The Isil Berat Barlan Center for Translational Medicine, Istanbul Jeffrey Modell Foundation Diagnostic Center for Primary Immune Deficiencies, Istanbul, Turkey
| | - Elif Karakoc-Aydiner
- Faculty of Medicine, Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.,The Isil Berat Barlan Center for Translational Medicine, Istanbul Jeffrey Modell Foundation Diagnostic Center for Primary Immune Deficiencies, Istanbul, Turkey
| | - Sara Sebnem Kilic
- Uludag University, Medical Faculty, Department of Pediatric Immunology and Rheumatology, Bursa, Turkey
| | - Hulya Kose
- Uludag University, Medical Faculty, Department of Pediatric Immunology and Rheumatology, Bursa, Turkey
| | - Nesrin Gulez
- Department of Pediatric Immunology and Allergy, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Ferah Genel
- Department of Pediatric Immunology and Allergy, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Ismail Reisli
- Department of Pediatric Immunology and Allergy, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Kamel Djenouhat
- Laboratory of Immunology, Department of Medical Biology, Rouiba Hospital, Algiers, Algeria
| | - Azzeddine Tahiat
- Laboratory of Immunology, Department of Medical Biology, Rouiba Hospital, Algiers, Algeria
| | - Rachida Boukari
- Department of Pediatrics, Mustapha Pacha University Hospital, University of Algiers, Algiers, Algeria
| | - Samir Ladj
- Department of Pediatrics, Mustapha Pacha University Hospital, University of Algiers, Algiers, Algeria
| | - Reda Belbouab
- Department of Pediatrics, Mustapha Pacha University Hospital, University of Algiers, Algiers, Algeria
| | - Yacine Ferhani
- Department of Pediatrics, Mustapha Pacha University Hospital, University of Algiers, Algiers, Algeria
| | - Brahim Belaid
- Department of Medical Immunology, University Hospital Center of Beni Messous, University of Algiers, Algiers, Algeria
| | - Reda Djidjik
- Department of Medical Immunology, University Hospital Center of Beni Messous, University of Algiers, Algiers, Algeria
| | - Nadia Kechout
- Department of Immunology, Pasteur Institute of Algeria/Faculty of Medicine, Algiers, Algeria
| | - Nabila Attal
- Department of Immunology, Pasteur Institute of Algeria/Faculty of Medicine, Algiers, Algeria
| | - Khalissa Saidani
- Department of Immunology, Pasteur Institute of Algeria/Faculty of Medicine, Algiers, Algeria
| | - Ridha Barbouche
- Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Aziz Bousfiha
- Laboratory of Clinical Immunology, Inflammation and Allergy, Faculty of Medicine and Pharmacy of Casablanca, King Hassan II University, Casablanca, Morocco
| | - Ali Sobh
- Department of Pediatrics, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ragheed Rizk
- Department of Pediatrics, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Marwa H Elnagdy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mona Al-Ahmed
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.,Department of Allergy, Al-Rashid Allergy Center, Kuwait University, Kuwait City, Kuwait
| | - Salem Al-Tamemi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Gulnara Nasrullayeva
- Department Immunology Research Laboratory, Azerbaijan Medical University, Baku, Azerbaijan
| | - Mehdi Adeli
- Allergy and Immunology Division, Pediatrics Department, Sidra Medicine, Doha, Qatar
| | - Maryam Al-Nesf
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Amel Hassen
- Allergy and Immunology Division, Pediatrics Department, Sidra Medicine, Doha, Qatar
| | - Cybel Mehawej
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Carla Irani
- Internal Medicine and Clinical Immunology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Andre Megarbane
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Jessica Quinn
- Jeffrey Modell Foundation (JMF), New York City, NY, USA
| | | | - László Maródi
- PID Clinical Unit and Laboratory, Department of Dermatology, Semmelweis University, Budapest, Hungary.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller University, New York, NY, USA
| | - Vicki Modell
- Jeffrey Modell Foundation (JMF), New York City, NY, USA
| | - Fred Modell
- Jeffrey Modell Foundation (JMF), New York City, NY, USA
| | - Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat 13110, PO Box 24923, Kuwait City, Kuwait. .,Allergy and Clinical Immunology Unit, Pediatric Department, Al-Sabah Hospital, Kuwait City, Kuwait.
| | - Raif S Geha
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, 1 Blackfan Circle, Karp, Bldg, 10th Floor, Boston, MA, 02115, USA.
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. .,Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, 14186, Huddinge, Stockholm, Sweden.
| |
Collapse
|
65
|
Thalhammer J, Kindle G, Nieters A, Rusch S, Seppänen MRJ, Fischer A, Grimbacher B, Edgar D, Buckland M, Mahlaoui N, Ehl S. Initial presenting manifestations in 16,486 patients with inborn errors of immunity include infections and noninfectious manifestations. J Allergy Clin Immunol 2021; 148:1332-1341.e5. [PMID: 33895260 DOI: 10.1016/j.jaci.2021.04.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Inborn errors of immunity (IEI) are rare diseases, which makes diagnosis a challenge. A better description of the initial presenting manifestations should improve awareness and avoid diagnostic delay. Although increased infection susceptibility is a well-known initial IEI manifestation, less is known about the frequency of other presenting manifestations. OBJECTIVE We sought to analyze age-related initial presenting manifestations of IEI including different IEI disease cohorts. METHODS We analyzed data on 16,486 patients of the European Society for Immunodeficiencies Registry. Patients with autoinflammatory diseases were excluded because of the limited number registered. RESULTS Overall, 68% of patients initially presented with infections only, 9% with immune dysregulation only, and 9% with a combination of both. Syndromic features were the presenting feature in 12%, 4% had laboratory abnormalities only, 1.5% were diagnosed because of family history only, and 0.8% presented with malignancy. Two-third of patients with IEI presented before the age of 6 years, but a quarter of patients developed initial symptoms only as adults. Immune dysregulation was most frequently recognized as an initial IEI manifestation between age 6 and 25 years, with male predominance until age 10 years, shifting to female predominance after age 40 years. Infections were most prevalent as a first manifestation in patients presenting after age 30 years. CONCLUSIONS An exclusive focus on infection-centered warning signs would have missed around 25% of patients with IEI who initially present with other manifestations.
Collapse
Affiliation(s)
- Julian Thalhammer
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Pediatrics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerhard Kindle
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexandra Nieters
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Rusch
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mikko R J Seppänen
- Rare Disease and Pediatric Research Centers, Hospital for Children and Adolescents and Adult Immunodeficiency Unit, Inflammation Center, University of Helsinki and HUS Helsinki, University Hospital, Helsinki, Finland
| | - Alain Fischer
- Pediatric Immuno-Haematology and Rheumatology Unit, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Bodo Grimbacher
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF - German Center for Infection Research, Satellite Center Freiburg, Freiburg, Germany; CIBSS - Centre for Integrative Biological Signalling Studies, Albert-Ludwigs University, Freiburg, Germany; RESIST - Cluster of Excellence 2155 to Hanover Medical School, Satellite Center Freiburg, Freiburg, Germany
| | - David Edgar
- St James's Hospital, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland
| | - Matthew Buckland
- Institute of Immunity and Transplantation, University College London, United Kingdom; Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Nizar Mahlaoui
- Pediatric Immuno-Haematology and Rheumatology Unit, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; CIBSS - Centre for Integrative Biological Signalling Studies, Albert-Ludwigs University, Freiburg, Germany.
| | | |
Collapse
|
66
|
Vilela MMDS. Human Inborn Errors of Immunity (HIEI): predominantly antibody deficiencies (PADs): if you suspect it, you can detect it. J Pediatr (Rio J) 2021; 97 Suppl 1:S67-S74. [PMID: 33245895 PMCID: PMC9432301 DOI: 10.1016/j.jped.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This minireview gathers the scientific foundations of the literature on genetic errors in the development of the humoral immune system to help pediatricians suspect these defects. SOURCES A systemic search using the PubMed MEDLINE database was performed for all Predominantly Antibody Deficiencies (PADs) described in the 2020 IUIS Expert Committee for PID classification system, combined with terms for hypogammaglobulinemia. Search terms for PADs were based on the listed names and affected genes as classified by the IUIS 2020. Abstracts of the results were reviewed to find relevant case series, review articles of PADs associated with infection, opportunistic infection, autoimmunity, cytopenias, malignancies, inflammatory diseases, neurological and respiratory diseases. References from relevant articles were further reviewed for additional references. Relevant findings were grouped in accordance with the IUIS 2020 classification system. Clinical and genetic features, if known, were described. DATA SYNTHESIS PADs refer to impaired antibody production due to molecular defects intrinsic to B cells or a failure of interaction between B and T cells. The patients develop recurrent or chronic infection or respond to the antigens with dysregulation of the immune function, causing severe allergy, autoimmunity, inflammation, lymphoproliferation and malignancy. The diagnosis is a combined exercise of clinical and laboratory investigation similar to that performed by Bruton (1952). In the context of SARS-CoV-2 infection, the experience of XLA and CVID patients has been surprising. Variants in 39 genes were reported as causing PADs, but the clinical heterogeneity within each variant is not clear. CONCLUSION Bruton (1952) used clinical expertise and protein electrophoresis to identify XLA. The IUIS (2020) committee used immunoglobulins and B lymphocyte to characterize PADs. Pediatricians should suspect it to detect it and prevent morbidities that can have an astonishing and irreversible impact on the child's life.
Collapse
Affiliation(s)
- Maria Marluce Dos Santos Vilela
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Centro de Investigação em Pediatria, Departamento de Pediatria, Divisão de Alergia e Imunologia Pediátricas, Campinas, SP, Brazil.
| |
Collapse
|
67
|
Abstract
PURPOSE OF REVIEW Healthcare has already been impacted by the fourth industrial revolution exemplified by tip of spear technology, such as artificial intelligence and quantum computing. Yet, there is much to be accomplished as systems remain suboptimal, and full interoperability of digital records is not realized. Given the footprint of technology in healthcare, the field of clinical immunology will certainly see improvements related to these tools. RECENT FINDINGS Biomedical informatics spans the gamut of technology in biomedicine. Within this distinct field, advances are being made, which allow for engineering of systems to automate disease detection, create computable phenotypes and improve record portability. Within clinical immunology, technologies are emerging along these lines and are expected to continue. SUMMARY This review highlights advancements in digital health including learning health systems, electronic phenotyping, artificial intelligence and use of registries. Technological advancements for improving diagnosis and care of patients with primary immunodeficiency diseases is also highlighted.
Collapse
|