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Vol. 45. Issue 1.
Pages 55-62 (January - February 2017)
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Vol. 45. Issue 1.
Pages 55-62 (January - February 2017)
Original Article
DOI: 10.1016/j.aller.2016.04.014
Prospective evaluation of Streptococcus pneumoniae serum antibodies in patients with primary immunodeficiency on regular intravenous immunoglobulin treatment
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R.M. Simão-Gurgea, B.T. Costa-Carvalhob, F.A. Nobreb, I.G.S. Gonzalezb, M.I. de Moraes-Pintoa,
Corresponding author
m.isabelmp@uol.com.br

Corresponding author.
a Division of Pediatric Infectious Diseases, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
b Division of Allergy Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Tables (4)
Table 1. Demographic characteristics of study patients.
Table 2. Medical records of patients in the study period (AOM, acute otitis media; ARI, acute respiratory infection; PNM, pneumonia).
Table 3. Prospective immunological evaluation of patients on regular use of IGIV.
Table 4. Pneumococcal antibodies in different lots of commercially available preparations of intravenous immunoglobulin used in study.
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Abstract
Background

This is a prospective study that assessed pneumococcal antibody levels in PID patients under intravenous immunoglobulin (IVIG) treatment using different brands.

Methods

Twenty-one patients receiving regular IVIG every 28 days were invited to participate: 12 with common variable immunodeficiency, six with X-linked agammaglobulinaemia and three with hyper-IgM syndrome.

One blood sample was collected from each patient just prior to IVIG administration at a three-month time interval during one year. A questionnaire was filled in with patient's demographic data and history of infections during the study period. Streptococcus pneumoniae antibodies against six serotypes (1, 5, 6B, 9V, 14 and 19F) were assessed by ELISA both in patients’ serum (trough levels) and in IVIG samples.

Results

Median total IgG trough serum levels were 7.91g/L (range, 4.59–12.20). All patients had antibody levels above 0.35μg/mL to the six serotypes on all four measurements. However, only 28.6% of patients had pneumococcal antibodies for the six analysed serotypes above 1.3μg/mL on all four evaluations during the one-year period. No correlation was found between IgG trough levels and pneumococcal specific antibodies. Eighteen of the 21 patients (85.7%) had infections at some point during the 12-month follow-up, 62/64 (96.9%) clinically classified in respiratory tract infections, four of which were pneumonia.

Conclusions

Pneumococcal antibodies are present in a high range of concentrations in sera from PID patients and also in IVIG preparations. Even maintaining a recommended IgG trough level, these patients can be susceptible to these bacteria and that may contribute to recurrent respiratory infections.

Keywords:
Antibody deficiency
Hypogammaglobinaemia
Intravenous immunoglobulin
Pneumococcal infection
Primary immunodeficiency disease
Streptococcus pneumoniae

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