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

[Howard M Lederman]

Thanks to all who have responded so far.

My pt has no h/o diarrhea, nl serum albumin, and nl stool alpha-1 anti-trypsin  - so I doubt a GI explanation.

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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----- Original Message -----
From: "Kirkpatrick, Charles" <Charles.Kirkpatrick at ucdenver.edu>
Date: Friday, July 17, 2009 3:46 pm
Subject: Re: [PAGID] patient who lacks long-term memory antibody responses
To: "'pagid at list.clinimmsoc.org'" <pagid at list.clinimmsoc.org>



> Howard;  I have some thing similar inpatients with intestinal protein 

> leaks (intestinal lymphangiectasia and celiac disease).  The patient 

> with celiac disease had an antibody half-life of 9 days.  If you 

> decide to try IgG replacement, I suggest giving subcutaneously.  This 

> depot mode seems to have better efficacy.

>  

>  Chuck Kirkpatrick

>  

>  -----Original Message-----

>  From: pagid-bounces at list.clinimmsoc.org [ On Behalf Of Howard M Lederman

>  Sent: Thursday, July 16, 2009 12:50 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

>  

>  WARNING: E-mail sent over the Internet is not secure.

>  Information sent by e-mail may not remain confidential.

>  

>  DISCLAIMER: This e-mail is intended only for the

>  individual to whom it is addressed. It may be used only in accordance 

> with applicable laws. If you received this e-mail by mistake, please 

> notify the sender and destroy the e-mail.

>  

>