Sensorineural Hearing Loss in Selective Immunglobulin A Deficiency

Autoimmune Inner Ear Disease among Patients with Selective IgA Deficiency

OBJECTIVES

Autoimmune inner ear disease (AIED) is a distinct clinical entity from sudden sensorineural hearing loss. The purpose of this study was to investigate the clinical characteristics of AIED in patients with selective IgA deficiency (sIgAD).

MATERIALS AND METHODS

This retrospective observational study was based on data from the Leumit Healthcare Services database in Israel. We searched all subjects aged ≥12 years who had undergone serum total IgA measurements during 2004-2014 for any reason. The sIgAD patients included all subjects with serum IgA of ≤7 mg/dL (0.07 g/L). A control group was randomly sampled from the full study population (n ≈ 730,000) with a case-control ratio of 10 controls for each case (1:10).

RESULTS

Among 347 subjects with sIgAD, we identified 9 patients with concomitant AIED (sIgAD + AIED group). This group was characterized by a higher prevalence of allergic diseases (8 patients; 88.9%) than sIgAD patients without AEID (sIgAD + AIED group; 153 patients; 45.2%; p = 0.014). Both systemic diseases (3 patients; 33.3%) and organ-specific autoimmune diseases (7 patients; 77.8%) were more prevalent in the sIgAD + AIED group (sIgAD + AIED group: 19 patients 5.5%, p = 0.015; sIgAD - AEID group: 76 patients, 21.9%, p < 0.001), with an OR of 8.39 (1.94-36.19; p = 0.004). sIgAD patients with and without AIED were characterized by a higher prevalence of documented episodes of acute otitis media, allergic diseases, and autoimmune diseases than the control group.

CONCLUSION

The study exposes a significant association between AIED and sIgAD. We believe that sIgAD has to be excluded in AIED patients.

Otitis Media and Inborn Errors of Immunity

PURPOSE OF REVIEW

The aim of this review is as follows: (1) to present the role of otitis as a warning sign for inborn errors of immunity (IEI), (2) to establish which patients presenting otitis should be investigated for IEI, (3) to review data about main IEI associated with otitis-prone patients.

RECENT FINDINGS

Otitis media is a very common infection in general population. The concept of otitis-prone children established a certain frequency of the infections in order to look for conditions leading to them. The confirmation of middle ear impairment by specialists has demonstrated better confiability. The hallmarks for immunologic evaluation are the presence of complications as mastoiditis and membrane perforation, failure to thrive, and additional respiratory symptoms. Humoral immunodeficiencies have been more frequently described in association with otitis-prone patients, for example, hypogammaglobulinemia, MBL deficiency, and IEI associated with major syndromes. Most of the patients with confirmed IEI present otitis as one of the recurrent infections. It is suggested the investigation of immune defects in patients with otitis, and the following warning signs are suggested: Otitis evolving with mastoiditis, abscesses, or systemic infections; no response to appropriate antibiotic therapy; otitis media associated with other infections; recurrent otitis leading to failure to thrive and general developmental delay; and family history of primary immunodeficiency and/or consanguinity.

Immunoglobulin A deficiency in children, an undervalued clinical issue

Immunoglobulin A (IgA) is the principal antibody in secretions that bathe the gastrointestinal and respiratory mucosal surfaces and acts as an important first line of defense against invasion of pathogenic micro-organisms. The reported prevalence rate of complete IgA deficiency in healthy children ranges from 1:170 to 1:400, and as a solitary condition, it is often considered of limited clinical importance. However, patients with IgA deficiency can develop recurrent respiratory and gastrointestinal infections, as well as allergic and autoimmune diseases. In children referred for recurrent respiratory tract infections, the observed prevalence rate increases more than tenfold. This review discusses several aspects of IgA deficiency in children, including immunologic and microbiome changes in early childhood and the potential consequences of this condition in later life. It illustrates the importance of early identification of children with impaired IgA production who deserve appropriate clinical care and follow-up.