Allergol Immunopathol (Madr). 2016 Jul 29. pii: S0301-0546(16)30076-3. doi: 10.1016/j.aller.2016.04.014. [Epub ahead of print]

Prospective evaluation of Streptococcus pneumoniae serum antibodies in patients with primary immunodeficiency on regular intravenous immunoglobulin treatment.

Simão-Gurge RM1, Costa-Carvalho BT2, Nobre FA2, Gonzalez IG2, de Moraes-Pinto MI3.

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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.

Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

KEYWORDS:

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

PMID: 27480789 DOI: 10.1016/j.aller.2016.04.014

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