[CIS-PAGID] Quick & Dirty Neoantigen?

[Javier Chinen]

The levels of anti-pneumococcal serotypes antibodies that can possibly be attributed to IVIG are about  1- 2 ug/mL. (based on calculations of volume distribution and assuming that plasma donors are not hyperimmunized; and in our own patient data) CVID patients on IVIG usually have their baseline titers under 1.
You might be able to discriminate function if right after PCV 13 you notice an increase on titers to the 13 serotypes in the vaccine but not other serotypes, measured in a commercial panel of 20 serotypes and compared to before immunization.
PCV13 mmunization would be done 2 weeks after IVIG administration, when IgG levels are very close to trough level.
Titers are measured before IVIG administration.
I might find an increase of one serotype not in PCV13, but not the others, very little gray zone. 
If for some reason baseline titers are above 2 ug/ml, this protocol won't work because immunization does not increase predicatbly
 
The major advantage of this strategy is the relatively well standardized quantification of anti-pneumococcal titers, that can be obtained in a commercial lab easily, compared to Menactra or rabies vaccines.

 
Javier Chinen, MD, PhD 
Phone cell (281)825-2561
 




To: pagid at list.clinimmsoc.org
From: brian.vickery at duke.edu
Date: Wed, 10 Aug 2011 16:05:56 -0400
Subject: [CIS-PAGID] Quick & Dirty Neoantigen?


I follow a medically complex young man with vasculitis and hypogammaglobulinemia and for various reasons, completing the bacteriophage procedure is probably not feasible. Does anyone have experience using another neoantigen in patients on IVIG, ideally one that could be done in 4-6 wks? I had heard of folks using Menactra but can't find any literature on it (nor in a cursory search, a place to titer the antibody). Thought I'd throw it out to the group. 

Thanks for any thoughts- 
BPV 
___________________
Brian Vickery, MD
Division of Pediatric Allergy & Immunology
Duke University Medical Center
DUMC Box 2644, Durham NC 27710
919.681.2949

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