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Bez P, Warnatz K. Liver disease in primary antibody deficiencies. Curr Opin Allergy Clin Immunol 2024:00130832-990000000-00157. [PMID: 39329167 DOI: 10.1097/aci.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
PURPOSE OF REVIEW Liver disease has emerged as a major risk factor for increased mortality in patients with common variable immunodeficiency (CVID). This is mostly due to presinusoidal portal hypertension (PHTN) frequently secondary to nodular regenerative hyperplasia (NRH). Its pathogenesis is still poorly understood and treatment strategies for its various stages are often guided by trial and error. This review summarizes the most recent findings in the light of previous literature. RECENT FINDINGS In the last 2 years, different groups have addressed pathology, diagnostics, treatment, and liver transplantation. Histological examinations seem to support the pathogenetic sequence of T-cell mediated infiltration and damage of the sinusoidal space with secondary development of NRH, pericellular fibrosis, and the manifestation of PHTN. While markers of the early phase - beyond slight elevation of cholestatic enzymes - are still missing, elevated liver stiffness and splenomegaly above 16 cm longitudinal diameter have been suggested as warning signs for PHTN in CVID patients. Data on immunosuppressive treatment of this manifestation is still very heterogeneous, but a recent report on liver transplantation was encouraging for end stage liver disease. SUMMARY Liver disease deserves higher attention in the management of CVID. More studies are needed to understand its pathogenesis and optimal treatment.
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Affiliation(s)
- Patrick Bez
- Division of Immunodeficiency, Department of Rheumatology and Clinical Immunology
- Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Division of Immunodeficiency, Department of Rheumatology and Clinical Immunology
- Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Picado C, de Landazuri IO, Vlagea A, Bobolea I, Arismendi E, Amaro R, Sellarés J, Bartra J, Sanmarti R, Hernandez-Rodriguez J, Mascaró JM, Colmenero J, Vaquero EC, Pascal M. Spectrum of Disease Manifestations in Patients with Selective Immunoglobulin E Deficiency. J Clin Med 2021; 10:jcm10184160. [PMID: 34575269 PMCID: PMC8466644 DOI: 10.3390/jcm10184160] [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: 08/20/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Selective IgE deficiency (SIgED) has been previously evaluated in selected patients from allergy units. This study investigates the effects of SIgED on the entire population in a hospital setting and sought to delineate in detail the clinical aspects of SIgED. METHODS A retrospective study of the data obtained from electronic medical records of 52 adult patients (56% female) with a mean age of 43 years and IgE levels of <2.0 kU/L with normal immunoglobulin (Ig) IgG, IgA, and IgM levels, seen at our hospital, without selection bias, from 2010 to 2019. RESULTS Recurrent upper respiratory infections were recorded in 18 (34.6%) patients, pneumonia was recorded in 16 (30.7%) patients, bronchiectasis was recorded in 16 (30.7%) patients, and asthma was recorded in 10 (19.2%) patients. Eighteen patients (34.6%) suffered autoimmune clinical manifestations either isolated (19%) or combining two or more diseases (15%), Hashimoto's thyroiditis being the most frequent (19%), which was followed by arthritis (10%) and thrombocytopenia and/or neutropenia (5.7%). Other less frequent associations were Graves' disease, primary sclerosing cholangitis, Sjögren's syndrome, and autoimmune hepatitis. Eczematous dermatitis (15.3%), chronic spontaneous urticaria (17.3%), and symptoms of enteropathy (21%) were also highly prevalent. Thirty percent of patients developed malignancies, with non-Hodgkin lymphomas (13.4%) being the most prevalent. CONCLUSIONS The clinical manifestations of SIgED encompass a variety of infectious, non-infectious complications, and malignancy. Since it cannot be ruled out that some type of selection bias occurred in the routine assessment of IgE serum Ievels, prospective studies are required to better characterize SIgED and to determine whether it should be added to the list of antibody deficiencies.
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Affiliation(s)
- César Picado
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Correspondence:
| | - Iñaki Ortiz de Landazuri
- Immunology Department, CDB. Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.O.d.L.); (A.V.)
| | - Alexandru Vlagea
- Immunology Department, CDB. Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.O.d.L.); (A.V.)
| | - Irina Bobolea
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Ebymar Arismendi
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Rosanel Amaro
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Jacobo Sellarés
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Joan Bartra
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
| | - Raimon Sanmarti
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Department of Rheumatology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - José Hernandez-Rodriguez
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - José-Manuel Mascaró
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Department of Dermatology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Jordi Colmenero
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Liver Unit, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigaciones en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
| | - Eva C. Vaquero
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Department of Gastroenterology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Mariona Pascal
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Immunology Department, CDB. Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.O.d.L.); (A.V.)
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