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Stiehm ER, Roberts RL, Kaplan MS, Corren J, Jaracz E, Rico MJ. Pneumococcal seroconversion after vaccination for children with atopic dermatitis treated with tacrolimus ointment. J Am Acad Dermatol 2005; 53:S206-13. [PMID: 16021176 DOI: 10.1016/j.jaad.2005.04.064] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to determine the effect of treatment with topical tacrolimus on B- and T-cell immunity including the primary antibody response to pneumococcal polysaccharide vaccine in children with atopic dermatitis. METHODS In this open-label, noncomparative study, 23 children aged 2 to 12 years with moderate to severe atopic dermatitis were treated with tacrolimus 0.03% ointment twice daily for 7 weeks, immunized with a 23-valent pneumococcal polysaccharide vaccine after 3 weeks of treatment, and had their antibody response measured (for 12 pneumococcal serotype antigens present in the vaccine) before and 4 weeks after vaccination. None had received pneumococcal vaccine before the study. Patient antibody and cellular immune responses were assessed at each study visit (baseline, week 3, and week 7). RESULTS No significant changes in complete blood cell count, lymphocyte subsets, CD4/CD8 ratio, immunoglobulin levels, antibody titers to tetanus and Haemophilus influenzae , or lymphoproliferative responses were noted during the tacrolimus ointment treatment period. Tacrolimus blood levels were 1 ng/mL or less in all 23 children. Protective pneumococcal titers to all 12 serotypes were observed in 2 of 23 (9%) children prevaccination and in 16 of 23 (70%) children postvaccination. All 6 children who had protective titers to 0 to 5 of the 12 serotypes developed protective titers to an additional 5 to 11 serotypes. Of the patients, 91% had a greater than 4-fold increase in titer for at least 4 of 12 pneumococcal serotypes. CONCLUSION Topical application of tacrolimus ointment does not affect the serologic response to pneumococcal vaccine or interfere with preexisting T- and B-cell immune responses.
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Affiliation(s)
- E Richard Stiehm
- Mattel Children's Hospital, University of California-Los Angeles, California 90095, USA.
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102
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Brodtman DH, Rosenthal DW, Redner A, Lanzkowsky P, Bonagura VR. Immunodeficiency in children with acute lymphoblastic leukemia after completion of modern aggressive chemotherapeutic regimens. J Pediatr 2005; 146:654-61. [PMID: 15870670 DOI: 10.1016/j.jpeds.2004.12.043] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the prevalence, duration, and a potential cause of humoral defect(s) in children with acute lymphoblastic leukemia (ALL) at least 1 year after completion of chemotherapy. STUDY DESIGN Antibody titers for mumps, rubeola, rubella, tetanus and diphtheria toxoid, poliovirus serotypes 1, 2,and 3, Haemophilus influenzae type b, varicella, and hepatitis B were obtained from 100 children with ALL. Children with non-protective titers to these microbial antigens were re-vaccinated and re-studied after anamnestic vaccine challenge. RESULTS The percent of children with ALL who had protective titers was markedly less than that anticipated for immunized control subjects. Longitudinally, many titers fluctuate between protective and non-protective antibody responses after re-immunization. The chemotherapy protocol used did not affect the ability of these children to express protective antibody responses. T-, B-, and NK-cell numbers and proliferative responses to mitogens were all normal. Age correlated with titer results for certain vaccines. CONCLUSIONS Children in remission from ALL have a high prevalence of humoral immune defects that are not related to any specific chemotherapy regimen. This antibody deficiency may place children with ALL at risk for the development of these bacterial and viral diseases, even after completion of chemotherapy. Pediatricians, oncologists, or both should periodically monitor humoral immunity after chemotherapy and re-vaccinate these children, as needed, to ensure prolonged immunoprotection.
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Affiliation(s)
- Daniel H Brodtman
- Division of Allergy/Immunology, Department of Pediatrics, Schneider Children's Hospital of the North Shore-Long Island Jewish Health System, 410 Lakeville Road, New Hyde Park, NY 11042, USA
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103
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Bonilla FA, Bernstein IL, Khan DA, Ballas ZK, Chinen J, Frank MM, Kobrynski LJ, Levinson AI, Mazer B, Nelson RP, Orange JS, Routes JM, Shearer WT, Sorensen RU. Practice parameter for the diagnosis and management of primary immunodeficiency. Ann Allergy Asthma Immunol 2005; 94:S1-63. [PMID: 15945566 DOI: 10.1016/s1081-1206(10)61142-8] [Citation(s) in RCA: 311] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Francisco A Bonilla
- Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA
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Grimbacher B, Schäffer AA, Peter HH. The genetics of hypogammaglobulinemia. Curr Allergy Asthma Rep 2004; 4:349-58. [PMID: 15283873 DOI: 10.1007/s11882-004-0083-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Etiologies for human hypogammaglobulinemias are diverse and include genetic and nongenetic causes. Although recent reviews focus on the complex genetics of common variable immunodeficiency, in this review, we survey different causes of hypogammaglobulinemias and discuss possible mechanisms.
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Affiliation(s)
- Bodo Grimbacher
- Division of Rheumatology and Clinical Immunology, Medical School, University of Freiburg, Germany.
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105
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Picard C, Puel A, Bustamante J, Ku CL, Casanova JL. Primary immunodeficiencies associated with pneumococcal disease. Curr Opin Allergy Clin Immunol 2004; 3:451-9. [PMID: 14612669 DOI: 10.1097/00130832-200312000-00006] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Streptococcus pneumoniae may cause disease in patients with a variety of primary immunodeficiencies. However, no previous review has dealt with the issue of which primary immunodeficiencies predispose affected individuals to pneumococcal disease. We thus reviewed the medical literature on cases of S. pneumoniae infection in patients with primary immunodeficiency diseases, with a particular emphasis on invasive pneumococcal disease. RECENT FINDINGS Primary immunodeficiency diseases comprise over 100 conditions, each associated with a variety of infections. Patients at high risk for pneumococcal disease include most if not all B-cell defects (whether due to an intrinsic B-cell anomaly or an impaired T-cell help), deficiencies of early components of the classical pathway of complement and C3 deficiency, congenital asplenia, anhidrotic ectodermal dysplasia with immunodeficiency (caused by impaired NF-kappaB activation), and interleukin-1 receptor associated kinase-4 deficiency. Patients with other complement deficiencies (alternative and third pathway) and hyperimmunoglobulin E syndrome show a lower risk, whereas patients with other known primary immunodeficiencies, such as phagocytic disorders, do not appear to be particularly vulnerable to S. pneumoniae. SUMMARY Antibody- and complement-mediated opsonization, splenic macrophages and interleukin-1 receptor associated kinase-4- and nuclear factor kappaB-mediated immune responses are crucial for protective immunity to S. pneumoniae. This information is useful, not only in increasing our understanding of human immunity to S. pneumoniae, but also in the diagnostic investigation of patients with pneumococcal disease.
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Affiliation(s)
- Capucine Picard
- Pediatric Immunology-Hematology Unit, Necker-Enfants Malades Hospital, University of Paris René Descartes, Paris, France, EU.
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106
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Tangsinmankong N, Kamchaisatian W, Day NK, Sleasman JW, Emmanuel PJ. Immunogenicity of 23-valent pneumococcal polysaccharide vaccine in children with human immunodeficiency virus undergoing highly active antiretroviral therapy. Ann Allergy Asthma Immunol 2004; 92:558-64. [PMID: 15191025 DOI: 10.1016/s1081-1206(10)61764-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The 23-valent pneumococcal polysaccharide vaccine (23PSV) has been recommended for children infected with human immunodeficiency virus (HIV); however, the efficacy of this vaccination in HIV-infected children undergoing highly active antiretroviral therapy (HAART) has not been studied. OBJECTIVE To study the immunogenicity and immunologic protection of 23PSV in HIV-infected children after stable HAART. METHODS Serotype-specific IgG antibodies to 12 pneumococcal capsular polysaccharides were analyzed before and after 23PSV vaccination in 41 HIV-infected children undergoing HAART and compared with 95 HIV-negative control children. Seropositivity, clinical protection, and additional clinical protection from 23PSV were calculated based on serotype specific IgG antibody levels and on the known incidence of these serotypes for causing invasive disease. RESULTS Children with HIV infection undergoing HAART developed a significant increase in specific IgG levels to Streptococcus pneumoniae after 23PSV vaccination (0.95 vs 1.84 micro/gmL, P < .001). The HIV-infected children with CD4+ cell counts of 25% or higher at the time of vaccination developed a higher additional clinical protection gain from 23PSV vaccination than did children with a lower percentage of CD4+ cells. CONCLUSIONS HIV-infected children undergoing stable HAART develop a significant immunologic response to 23PSV, especially those with higher T-cell counts and lower viral loads at the time of vaccination.
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Affiliation(s)
- Nutthapong Tangsinmankong
- Department of Pediatrics, University of South Florida/All Children's Hospital, St. Petersburg, Florida 33701, USA.
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107
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Schauer U, Stemberg F, Rieger CHL, Büttner W, Borte M, Schubert S, Möllers H, Riedel F, Herz U, Renz H, Herzog W. Levels of antibodies specific to tetanus toxoid, Haemophilus influenzae type b, and pneumococcal capsular polysaccharide in healthy children and adults. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2003; 10:202-7. [PMID: 12626443 PMCID: PMC150524 DOI: 10.1128/cdli.10.2.202-207.2003] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Antibody levels specific for capsular polysaccharides of Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) and for tetanus toxoid were measured in serum samples of 386 age-stratified subjects. The study group consists of healthy adult blood donors and hospitalized children undergoing elective surgery, excluding individuals with a history of infection. In children, anti-tetanus toxoid antibody levels displayed two peaks of 1.20 IU/ml (20.4 mg/liter) and 1.65 IU/ml (28.1 mg/liter) related to the schedule of routine childhood immunization in the first year and at 8 years of age. Eighty percent of the antibodies are of the immunoglobulin G1 (IgG1) isotype. For pneumococcal capsular polysaccharide (PCP), the specific antibody levels represent the acquisition of natural immunity. The initial concentration of 9.2 mg/liter was low in infancy (0.5 to 1 years of age) and remained low until 3 to 4 years of age (14.6 mg/liter). During this period PCP antibodies were almost 100% of the IgG2 subclass. Thereafter, IgG anti-PCP antibody titers increased steadily to adult levels (59.5 mg/liter). The data are intended to provide reference ranges to aid in the interpretation of specific antibody determinations in the clinical setting.
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Affiliation(s)
- Uwe Schauer
- Klinik für Kinder- und Jugendmedizin der Ruhr Universität, Bochum, Germany.
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108
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COSTA-CARVALHO BEATRIZTAVARES, COCCO RENATARODRIGUES, RODRIGUES WALDINEIM, COLLA VIVIANEA, SOLÉ DIRCEU, CARNEIRO-SAMPAIO MAGDAM. Pneumonias de repetição em paciente com deficiência de anticorpos e imunoglobulinas normais. ACTA ACUST UNITED AC 2002. [DOI: 10.1590/s0102-35862002000300008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
É relatado o caso de uma menina de sete anos de idade com infecções de vias aéreas de repetição (otites, pneumonias e sinusites) desde os cinco meses de vida. A avaliação imunológica demonstrou produção inadequada de anticorpos ao Streptococcus pneumoniae após imunização para todos os sorotipos (1, 3, 5, 6, 9 e 14) testados, embora a paciente apresentasse níveis normais de imunoglobulinas. A avaliação radiológica, no momento da admissão, demonstrou presença de atelectasias difusas associadas a bronquiectasias. Após início do tratamento com imunoglobulina endovenosa e fisioterapia respiratória houve esvaecimento gradual até reversão das alterações radiológicas. Demonstrou-se, assim, a importância de um diagnóstico preciso para início de tratamento específico, com melhora gradual do quadro clínico e radiológico, evitando seqüelas pulmonares irreversíveis.
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109
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Lahiri T, Waltz DA. Preimmunization anti-pneumococcal antibody levels are protective in a majority of patients with cystic fibrosis. Pediatrics 2001; 108:E62. [PMID: 11581470 DOI: 10.1542/peds.108.4.e62] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Although invasive pneumococcal disease is infrequent in cystic fibrosis (CF), it is recommended that all patients with CF receive pneumococcal immunization. As part of a comprehensive program to immunize our clinic population, we obtained preimmunization anti-pneumococcal antibody levels. We hypothesized that the percentage of CF patients without protective levels of anti-pneumococcal antibody levels would be high, as they are exposed to frequent antibiotic therapy that may eradicate organisms before generation of an antibody response. METHODS An observational study of 100 patients with CF, aged 1 to 39 years, was conducted in a regional CF center. Preimmunization anti-pneumococcal antibody levels against 6 serotypes were measured by enzyme-linked immunosorbent assay. Protective antibody levels were defined as >200 ng/mL. RESULTS A majority of CF patients-61% to 100%, depending on age and serotype-had protective levels of pneumococcal antibody. There was a significant positive correlation between antibody level and age for 5 of the 6 serotypes tested. CONCLUSIONS In contradistinction to our hypothesis, the majority of CF patients have protective preimmunization anti-pneumococcal antibody levels. However, a significant proportion-between 17% and 39%, depending on the serotype-did not exhibit adequate levels. Therefore, we concur with current recommendations for pneumococcal immunization in CF.
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Affiliation(s)
- T Lahiri
- Division of Respiratory Diseases, Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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110
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Abstract
Infection with Streptococcus pneumoniae remains a major global health burden meaning the development of effective vaccines is urgently needed. The current 23-valent polysaccharide vaccine has been shown to prevent pneumococcal pneumonia in immunocompetent young adults, but not in elderly persons. However, in prevention of invasive pneumococcal disease, the vaccine is efficacious in the elderly and may also be effective in some groups of immunocompromised patients. The polysaccharide vaccine is, therefore, recommended in all older (> or = 55-65 yrs of age) adults and in young children (>2 yrs of age) who have a high risk for pneumococcal disease. Revaccination can be safely performed and is recommended 5 yrs after the first dose. In children <2 yrs of age, the new polysaccharide-protein conjugate vaccines, including 7-11 serotypes, seem to be effective in the prevention of invasive disease, severe pneumonia and serotype-specific (and vaccine-related types) otitis media. The low serotype coverage, need for repeated doses, and high price, may decrease the usefulness of the new conjugates. However, the included serotypes correspond to those most often associated with penicillin resistance and vaccination is, therefore, a possible tool in limiting the spread of antibiotic-resistant pneumococci.
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Affiliation(s)
- A Ortqvist
- Karolinska Institutet and Dept of Infectious Diseases, Karolinska Hospital, Stockholm, Sweden
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111
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Inostroza J, Vinet AM, Retamal G, Lorca P, Ossa G, Facklam RR, Sorensen RU. Influence of patient age on Streptococcus pneumoniae serotypes causing invasive disease. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2001; 8:556-9. [PMID: 11329457 PMCID: PMC96100 DOI: 10.1128/cdli.8.3.556-559.2001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
All clinical S. pneumoniae specimens isolated from patients with invasive or sterile-site infections admitted to one regional general hospital in southern Chile were collected during a 5-year period (February 1994 to September 1999). A total of 247 strains belonging to 50 serotypes were isolated in this survey: 69 in patients under 5 years of age, 129 in patients 5 to 64 years old, and 49 from patients 65 years and older. Eight serotypes were identified in all age groups, while all other serotypes were found exclusively in one age group or in patients over 4 years of age. Serotype 3 was never found in patients under 5 years old, and serotype 14 was not found in patients >64 years of age. There was no difference in the serotypes causing infection in each one of the 5 years of the survey. Our results suggest that both bacterial virulence factors and host factors play an important role in the selection of S. pneumoniae serotypes causing invasive infection. Possible host factors include age-related differences in the immune response. Comparative studies with other areas of the world may help to further understanding of our observations in southern Chile.
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Affiliation(s)
- J Inostroza
- Immunology Laboratory, Hospital Regional de Temuco, Chile
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112
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Leiva LE, Butler B, Hempe J, Ortigas AP, Sorensen RU. Up-regulation of CD40 ligand and induction of a Th2 response in children immunized with pneumococcal polysaccharide vaccines. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2001; 8:233-40. [PMID: 11238201 PMCID: PMC96042 DOI: 10.1128/cdli.8.2.233-240.2001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We wished to determine whether pneumococcal polysaccharide antigens induce mRNA expression of CD40 ligand (CD40L) and Th1 or Th2 cytokines in unimmunized individuals in vitro and whether immunization with the 23-valent pneumococcal polysaccharide vaccine induces changes in CD40L and cytokine mRNA expression. Children with recurrent respiratory infections were studied before and 4 to 6 weeks after receiving the pneumococcal vaccine. One patient who failed to respond to the polysaccharide vaccine subsequently received a single dose of the experimental 7-valent pneumococcal conjugate vaccine. Unimmunized healthy adults were included as controls. Quantification of mRNA expression of CD40L, interleukin-4 (IL-4), IL-12p40, and gamma interferon (IFN-gamma) was performed by reverse transcription-PCR and enzyme-linked immunosorbent assay (ELISA)-PCR with resting and stimulated peripheral blood mononuclear cells. Serum immunoglobulin G (IgG) anti pneumococcal antibody levels were measured by ELISA. The results showed a significant increase in the expression of mRNAs for CD40L and IL-4, but not IL-12p40 or IFN-gamma, in stimulated cultures from unimmunized individuals. CD40L and IL-4 mRNA expression was significantly higher in postimmunization than in preimmunization samples stimulated with the individual pneumococcal serotypes. These results suggest that pneumococcal polysaccharide antigens specifically up-regulate CD40L expression and induce a Th2 response in vitro which parallels the increase in IgG antipneumococcal antibody levels in serum.
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Affiliation(s)
- L E Leiva
- Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital, 1542 Tulane Ave., New Orleans, LA 70112-2822, USA.
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113
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Gennery AR, Cant AJ, Baldwin CI, Calvert JE. Characterization of the impaired antipneumococcal polysacharide antibody production in immunosuppressed pediatric patients following cardiac transplantation. J Clin Immunol 2001; 21:43-50. [PMID: 11321238 DOI: 10.1023/a:1006793032290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We previously have demonstrated impaired pneumococcal polysaccharide IgG antibody responses in children immunosuppressed following cardiac transplantation in early childhood. We have further characterized the antibody defect. To further investigate the production of antibody, antipneumococcal polysaccharide (PPS) specific IgM, IgG, IgG subclasses, and IgA were measured in postvaccination sera by enzyme-linked immunosorbent assay. Two groups were studied: posttransplant children who made pneumococcal antibody in vivo following natural exposure or PPS immunization (R) and those with an impaired response (NR). There was no difference in IgM or IgA levels between R and NR. IgG and IgG2 levels were higher in R than NR (P = 0.002), even after adsorption of nonspecific common cell wall antigen antibody. Differences in anti-pneumococcal antibody levels suggest that immunoglobulin isotype switching from IgM to IgG and particularly IgG2 is impaired in patients immunosuppressed at a young age. These findings confirm data regarding the effect of immunosuppressive agents derived from animal models in humans.
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Affiliation(s)
- A R Gennery
- Department of Pediatric Immunology, Newcastle General Hospital, Newcastle upon Tyne, England
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114
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Abstract
Antibodies have a crucial role in protecting against infections, and antibody deficiencies are the commonest primary and secondary immunodeficiencies. Antibody deficiencies may be the only abnormality present in a patient, or they may be present and aggravate the symptoms of various other conditions. Because the presence of an antibody deficiency is difficult to predict from clinical presentation, physicians should perform an evaluation of antibody-mediated immunity, even knowing that, in many cases, the results are normal. When immunizations are included as a part of the evaluation, many patients experience a benefit from enhanced immunity against common pathogens. Some alternative practical approaches to the evaluation of patients with recurrent infections are outlined in Figure 8. Referral to a clinical immunologist can be based on the presence of recurrent infections, a positive family history without prior evaluation by a pediatrician, or abnormal immunologic findings that require an advanced evaluation. In any case, a close collaboration between pediatrician and immunologist likely will result in an accurate diagnosis and better treatment of patients with antibody-deficiency syndromes and their families.
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Affiliation(s)
- R U Sorensen
- Division of Allergy/Immunology, Department of Pediatrics and the Allergy/Immunology Training Program, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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115
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Javier FC, Moore CM, Sorensen RU. Distribution of primary immunodeficiency diseases diagnosed in a pediatric tertiary hospital. Ann Allergy Asthma Immunol 2000; 84:25-30. [PMID: 10674561 DOI: 10.1016/s1081-1206(10)62736-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Advances in immunologic techniques in recent years have led to increased recognition of primary immunodeficiency disorders, with IgA deficiency the most common phenotype reported by most registries. There have also been reports of increased associated incidence of autoimmunity, allergy, and other diseases. OBJECTIVES We wished to determine the percentage of different primary immunodeficiency disorders seen in a pediatric tertiary hospital and to determine the association of primary immunodeficiency disorders with other diseases that are not part of classic immunodeficiency disorders. METHODS We performed a retrospective review of the patients referred to our allergy/immunology clinic for immunologic evaluation of recurrent infections during an 8-year period. We also reviewed pathology reports with postmortem diagnosis of immunodeficiencies not identified while patients were alive. RESULTS Of the 91 patients with primary immunodeficiency disorders evaluated, the majority had predominantly antibody deficiencies (67%). The most common phenotype was specific antibody deficiency with normal immunoglobulins (23.1%), defined as inability to mount an adequate response to pneumococcal polysaccharides followed by IgG2 subclass deficiency (17.6%). These two phenotypes were diagnosed mostly in the last 2 years of the survey. Associated diseases, found in 40% of patients, were mostly allergic conditions followed by syndromic/chromosomal disorders. CONCLUSION The study reveals that specific antibody deficiency with normal immunoglobulins followed by IgG2 subclass deficiency was the most frequently diagnosed primary immunodeficiency disorder in our patient population. It also indicates that immunodeficiency disorders should be considered in patients with other abnormalities like allergic and syndromic/chromosomal disorders that present with recurrent infections.
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Affiliation(s)
- F C Javier
- Department of Pediatrics, Louisiana State University Medical Center, New Orleans 70112-2822, USA
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116
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Luo W, Fine J, Garg M, Kaplan AM, Bondada S. Interleukin-10 enhances immune responses to pneumococcal polysaccharides and sheep erythrocytes in young and aged mice. Cell Immunol 1999; 195:1-9. [PMID: 10433791 DOI: 10.1006/cimm.1999.1516] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Antibody responses to pneumococcal polysaccharides are decreased in aged mice. Using a system to measure murine antibody responses to the Pnu-Imune vaccine, here we demonstrate that interleukin-10 (IL-10) has an adjuvant effect in enhancing the vaccine response in the aged. IL-10 increased the vaccine responses of B cells from aged mice in vitro only if either T cells or macrophages were also present. The need for T cells or macrophages could be substituted by cytokines such as IL-1 or IL-5, which are normally made by these accessory cells. Thus, IL-10 appeared to act on B cells directly but it worked in conjunction with other cytokines to induce an antigen specific response. In vivo studies showed that IL-10 administration enhanced antibody responses not only to thymic independent antigens but also to thymic-dependent antigens such as sheep erythrocytes. These data suggest that IL-10 may be useful in enhancing vaccine-specific responses in situations in which the host is immunocompromised.
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Affiliation(s)
- W Luo
- Department of Microbiology and Immunology, University of Kentucky, Lexington, Kentucky, 40536-0230, USA
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117
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Wasserman RL, Sorensen RU. Evaluating children with respiratory tract infections: the role of immunization with bacterial polysaccharide vaccine. Pediatr Infect Dis J 1999; 18:157-63. [PMID: 10048691 DOI: 10.1097/00006454-199902000-00016] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antibody deficiency syndromes are an important cause of recurrent infections in children. Today it is possible to perform a complete evaluation of antibody-mediated immunity leading to a definitive diagnosis of either normal or abnormal immunity in most patients. However, the interpretation of the results of IgG subclass determinations and specific antibody responses is still being defined. At this time our recommendation is that patients who meet the criteria for an evaluation of antibody-mediated immunity be referred to subspecialists trained in this evaluation until better criteria for normal have been developed. The possibility that protective amounts of antibodies against pneumococcal serotypes may develop only transiently must be considered in patients with recurrent infections after initial improvement after immunization, especially if IgG2 subclass deficiency is also present. In the future it may be possible to use a faster and more economical approach to evaluate patients with recurrent infections by immunization with pneumococcal vaccine and then measuring IgM, IgG and IgA along with postimmunization specific antipneumococcal antibody titers 4 to 6 weeks later. For this approach to become feasible, further studies comparing the information obtained from the evaluation of pre- and postimmunization antibody concentrations with that obtained from the evaluation of postimmunization concentrations alone are needed.
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Affiliation(s)
- R L Wasserman
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, USA.
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