[PAGID] patient who lacks long-term memory antibody responses

[Paris, Kenneth]

This clinical picture and immunologic profile is similar to what we have seen in a cohort of patients we have evaluated in our clinics over the past several years.  We are using gammaglobulin replacement in cases where antibiotic use does not result in significant periods of wellness, or if the QOL is poor.  The serial measurements of specific antibody levels, and the documentation of loss of protective titers correlates well with the patient's infection history.  We have documented this in our patients, and use this information for justification of IVIG.  The response to gammaglobulin has been overwhelmingly positive in nearly all of these patients.   
 
I agree with Javier, enumeration of lymphocytes and especially memory B cells will be interesting (they will be very low, I bet).  The search for a known cause of the abnormality probably won't be fruitful at this time (such as HIGES unless there are other aspects of the case that would lead you to that).  Our experience is that the memory B cell numbers are markedly reduced in this subset patients.   Ricardo Sorensen may want to comment further.  He and Lily Leiva have had at least one abstract at FOCIS in the last few years on this topic, and this is an area of interest in our lab.
 
Ken
 
Kenneth Paris MD, MPH
Assistant Professor of Pediatrics
Division of Allergy and Immunology
LSU Health Sciences Center
Children's Hospital of New Orleans
 
Mail: 
200 Henry Clay Avenue
Children's Hospital 
Research Institute for Children 4th Floor
New Orleans, LA 70118
Phone:  504-896-9589
Fax:  504-896-9311
Email:  kparis at lsuhsc.edu <mailto:kparis at lsuhsc.edu> 
 
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From: pagid-bounces at list.clinimmsoc.org on behalf of Howard M Lederman
Sent: Thu 7/16/2009 1:49 PM
To: PAGID LISTSERV
Subject: [PAGID] patient who lacks long-term memory antibody responses



I have a fascinating  12 yr old male patient with a history of recurrent infections (mostly upper and lower respiratory tract).  No individual infection has been overwhelmingly severe, but the sum of all infections leads to a significant number of school absences.

He has low IgG and IgM levels with normal IgA levels.  He makes normal IgG antibody responses to a wide variety of vaccines, but does not seem to be able to maintain long-term immunity.  (See attached spreadsheet.  Sheet 1 tabulates the antibody and immunglobulin levels; sheet 2 lists the immunizations.)

Is this a pattern that others have seen?    I am open to any ideas for further evaluation.  Would anyone offer this child gamma globulin? 


Howard
Howard M. Lederman, M.D., Ph.D. 
Professor of Pediatrics, Medicine and Pathology 
Division of Pediatric Allergy and Immunology 
Johns Hopkins Hospital - CMSC 1102 
600 N. Wolfe Street 
Baltimore, MD 21287-3923 
Phone: 410-955-5883 
Fax: 410-955-0229 
Email: Hlederm1 at jhem.jhmi.edu 

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