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

[Nicholas Rider]

Hi Dr. Lederman,

Thanks for sharing the interesting case.

I wondered how closely your patient's infection frequency correlates  
to his waning vaccine titers?  My reason for asking is that I wonder  
about hyperimmunization with non-live vaccines based upon titer levels  
or a routine schedule based upon what you already know about the  
kinetics of his dropping titers.  If it works, this would be less  
expensive than gamma globulin replacement and may be worth a try in a  
patient with relatively low risk (to this point) for serious bacterial  
infections.

It would be interesting to see how the patient responds to PhiX  
neoantigen.

Best Wishes,

Nick

Nicholas L. Rider, D.O.
Clinic for Special Children
535 Bunker Hill Road
Strasburg, PA 17579
Ph:  717-687-9407
Fx:   717-687-9237
nrider at clinicforspecialchildren.org



On Jul 16, 2009, at 2:49 PM, Howard M Lederman wrote:


> 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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>

>

> <Hodinko, Samuel.xls>