[CIS PIDD] [cis-pidd] Only diphteria response low????

[Seppänen Mikko]

Thanks

to both of you replying. Reassuring! 

Interestingly, when I yesterday told this response finding to the patient (her being a colleague), I compared it to HBV vaccine nonresponsiveness. She then told me that she was vaccinated repeatedly (2x3) against HBV until she responded. Was this noted in any of Your patients? 

Scientifically and biologically interesting, though hardly clinically of any major importance.

mikko

________________________________________
Lähettäjä: Howard Lederman [hlederm1 at jhmi.edu]
Lähetetty: 28. kesäkuuta 2013 16:52
Vastaanottaja: CIS-PIDD
Aihe: Re: [cis-pidd] Only diphteria response low????

We have seen a couple of patients like this who respond to everything but diphtheria toxoid.  I don't consider this to be biologically important.

Howard

Seppänen Mikko <Mikko.Seppanen at hus.fi> wrote:



Dear all,

a colleague of ours visited my office in April, she has moderately severe asthma and recurrent URT infections, and in my mind clinically no PIDD phenotype. No severe invasive infections and no p.o. corticosteroids for 2.5 years. She has no syndromic features and clinically only mild viral infections (w. prolonged asthma exacerbations), no noted chronic viral infections, and all her ab levels were normal in plasma, IgE only 58 (but capable of its production).

She had receved tetanus+diphtheria booster 2 years previously. We did check her vaccine responses since C.diphtheriae-Abs were low (and w/o vaccination her StpnAbs were also low), to rule out mild adult SPAD (had she not been an immunology-oriented colleague, I probably would not have checked any further).

After vaccination she has VERY strong responses to both strong T-B-ag/tetanus, and PnP/ B-ags (9/10 respond, up to titers of 180), but does not respond to weak T-B ag/ diphtheria (0.03-0.07 SPU/ml, threshold in our lab 0.1).

Have never seen this ab response pattern before, I clinically think it might be irrelevant (at least there isn't much I could do to help her), but would like to hear whether anyone in the group has seen this, does it ring any bells????

Maybe prof Ricardo Sorensen has seen this? We have not tested her memory Bs (J Clin Immunol. 2013 Jan;33 Suppl 1:S57-61).

Yours

mikko seppänen,
md phd
finland


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