[CIS PIDD] [cis-pidd] Sub-protective pneumococcal titers in a CVID patient on therapeutic doses of IgSQ and recurrent bronchitis

Thu Jan 22 14:34:11 EST 2015

Dear Soheil,

Two episodes in year is not much. I would not consider increasing Ig dosage in the first instance.

We had at least 3 CVIDs with recurrent bronchitis ( 6 - 8 times / year) . No bronchiectasis. 2 of them had colonisation with non-typable HI.   Cleared with prolonged course of antibiotics and bronchitis improved.

In the other one prophylactic Azithromycin resulted in significant improvement.

Is he a smoker ? , Does he have Chronic bronchitis ?

Best regards

Ravi

Dr Ravishankar Sargur
MD, FRCPath, FRCP
Consultant Clinical Immunologist & Clinical Lead
Protein Reference Unit, Immunology, NGH
Sheffield Teaching Hospitals Foundation NHS Trust.

Training Programme Director
Immunology
East Midlands Deanery and Yorkshire & Humber Deanery
Email : Ravishankar.sargur at sth.nhs.uk<mailto:Ravishankar.sargur at sth.nhs.uk>
Phone : 0114 2715704
Hayley Rowan ( Secrretary) : 0114 2269020
Fax : 0114 2269244

________________________________
From: Nacho Gonzalez [mailto:nachgonzalez at gmail.com]
Sent: 22 January 2015 19:20
To: CIS-PIDD
Subject: Re: [cis-pidd] Sub-protective pneumococcal titers in a CVID patient on therapeutic doses of IgSQ and recurrent bronchitis

Dear Soheil,

Nearly absent IgA and IgM increases the risk of upper respiratory tract infections in your patient. 2 episodes per year is not that much and you maintain the patient quite stable with decent trough IgG levels and minor infections. I would be hesitant to increase SQ dosage. But any answer to this precise question may be controversial.

Best regards,

Luis Ignacio Gonzalez-Granado
Immunodeficiencies Unit
Pediatric Hematology & Oncology Unit.
Pediatrics
Hospital 12 octubre.
Madrid. Spain

2015-01-22 20:06 GMT+01:00 Keller, Michael <MKeller at childrensnational.org<mailto:MKeller at childrensnational.org>>:
Hi Soheil,

Increasing his hizentra dose sounds like a very good move as we often (albeit in pediatric patients) see much higher levels achieved with subQ.

You mention no bronchiectasis - has he had a recent chest CT or MRI to ensure that there is no developing interstitial disease?

Best regards,
Mike

-------------------------

Michael D. Keller MD

Assistant Professor, Division of Allergy / Immunology

Center for Cancer and Immunology Research

Children's National Health System

111 Michigan Ave NW, Room 1W-314B

Washington, DC 20010

Clinic: 202.476.3016

Office: 202.476.5843

Fax: 202.476.2280

www.childrensnational.org<http://www.childrensnational.org>

________________________________
From: Soheil Chegini [schegini at yahoo.com<mailto:schegini at yahoo.com>]
Sent: Thursday, January 22, 2015 2:00 PM
To: CIS-PIDD
Subject: [cis-pidd] Sub-protective pneumococcal titers in a CVID patient on therapeutic doses of IgSQ and recurrent bronchitis
Dear all,

I am wondering what others would suggest to reduce the frequency of bronchitis in a 54 y.o. man with CVID who is on Hizentra 10 g SQ weekly and has an excellent IgG level (814 in 6/14 and 916 1/15). He has responded well to oral antibiotics (Ceftin and Augmentin x 10 each) for 2 episodes of bronchitis that he has had this fall with resolution of his symptoms. He is also treated for asthma with Symbicort 160/4.5 and his spirometry is stable at his baseline with some irreversible airflow obstruction. No bronchiectasis.

Here are his 14-serotype pneumococcal titers:
Type 1                   0.9
Type 3                   0.9
Type 4                   <0.3
Type 5                   1.4
Type 8                   1.0
Type 9                   0.7
Type 12                 0.4
Type 14                 3.3
Type 19                 1.4
Type 23                 0.9
Type 26                 1.1
Type 51                 1.3
Type 56                 1.2
Type 68                 0.7

These titers suggest adequate protection only against 4 of the 14 tested serotypes, but I am not inclined to increase his dose of Hizentra given his excellent total IgG. He does not produce any Ig (IgA,7 and IgM 11), and his pre-Treatment IgG was 151. He is tolerating the infusions well and I have no other excuse to change the Ig preparation.

I would very much appreciate your help and advice. Thank you very much in advance.

Best regards,
sc

Soheil Chegini, M.D.
Exton Allergy & Asthma Associates
656 West Lincoln Hwy.
Exton, PA 19341
Phone: (610) 269-3066
Fax: (610) 269-8615

---

The CIS-PIDD listserv is supported by:

[http://www.clinimmsoc.org/UserFiles/image/cis-pidd-list-logo_v1.jpg]
The science & practice of human immunology

P: +1.414.224.8095<tel:%2B1.414.224.8095>
E: info at clinimmsoc.org<mailto:info at clinimmsoc.org>

Not a member of CIS? Please visit www.clinimmsoc.org<https://urldefense.proofpoint.com/v2/url?u=https-3A__cis.execinc.com_edibo_Signup&d=AwMFaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=mERX_I8PKb0Uil9coedoT1CtvFqkSey45L0vbcX0oKI&m=JaOGFo4_5Jq9vzlvdgy8CzRmB8Lqx7EUj3mnJGo3db0&s=fiO4M9lr29xSXuX3oiI4Y7msICFzLccz33qCXOwq2QQ&e=> to join!

You are currently subscribed to cis-pidd as: mkeller at childrensnational.org<mailto:mkeller at childrensnational.org>.
To unsubscribe click here: http://lm.clinimmsoc.org/u?id=202536700.bba161e2ff9c9e1b35b1386869d41ea1&n=T&l=cis-pidd&o=45984314<https://urldefense.proofpoint.com/v2/url?u=http-3A__lm.clinimmsoc.org_u-3Fid-3D202536700.bba161e2ff9c9e1b35b1386869d41ea1-26n-3DT-26l-3Dcis-2Dpidd-26o-3D45984314&d=AwMFaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=mERX_I8PKb0Uil9coedoT1CtvFqkSey45L0vbcX0oKI&m=JaOGFo4_5Jq9vzlvdgy8CzRmB8Lqx7EUj3mnJGo3db0&s=mC_ZMdsoSEhncV6O35hlZQ_U_2awJk17VKhB7K9CEvA&e=>

________________________________
Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.

---

The CIS-PIDD listserv is supported by:

[http://www.clinimmsoc.org/UserFiles/image/cis-pidd-list-logo_v1.jpg]
The science & practice of human immunology

P: +1.414.224.8095<tel:%2B1.414.224.8095>
E: info at clinimmsoc.org<mailto:info at clinimmsoc.org>

Not a member of CIS? Please visit www.clinimmsoc.org<https://cis.execinc.com/edibo/Signup> to join!

You are currently subscribed to cis-pidd as: nachgonzalez at gmail.com<mailto:nachgonzalez at gmail.com>.
To unsubscribe click here: http://lm.clinimmsoc.org/u?id=183824481.b83ee7e83de457b4848325aafc56219c&n=T&l=cis-pidd&o=45984345

---

The CIS-PIDD listserv is supported by:

[http://www.clinimmsoc.org/UserFiles/image/cis-pidd-list-logo_v1.jpg]
The science & practice of human immunology

P: +1.414.224.8095
E: info at clinimmsoc.org

Not a member of CIS? Please visit www.clinimmsoc.org<https://cis.execinc.com/edibo/Signup> to join!

You are currently subscribed to cis-pidd as: ravishankar.sargur at sth.nhs.uk<mailto:ravishankar.sargur at sth.nhs.uk>.
To unsubscribe click here: http://lm.clinimmsoc.org/u?id=183824745.d44abf085b2893cde48f010bd9ad8489&n=T&l=cis-pidd&o=45984388

---
The CIS-PIDD listserv is supported by the Clinical Immunology Society
The science & practice of human immunology

P: +1.414.224.8095
E: info at clinimmsoc.org

Not a member of CIS? Please visit www.clinimmsoc.org to join!

You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://lm.clinimmsoc.org/u?id=183939985.3ea13d40a15475ac00ebbd9cd8a37d6d&n=T&l=cis-pidd&o=45984460
or send a blank email to leave-45984460-183939985.3ea13d40a15475ac00ebbd9cd8a37d6d at lists.clinimmsoc.org
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <https://pairlist7.pair.net/pipermail/pagid/attachments/20150122/3996d7f9/attachment-0001.html>