[CIS PIDD] [cis-pidd] Sub-protective pneumococcal titers in a CVID patient on therapeutic doses of IgSQ and recurrent bronchitis
Cunningham-Rundles, Charlotte
charlotte.cunningham-rundles at mssm.edu
Thu Jan 22 18:32:20 EST 2015
I have seen not great titers to pneumovax in other supposedly well treated CVID subjects. Have not known what to make of this.
Charlotte Cunningham-Rundles, MD, PhD
Departments of Medicine and Pediatrics
The David S Gottesman Professor
The Immunology Institute
Mount Sinai School of Medicine
1425 Madison Avenue
New York, NY 10029
Phone: 212 659 9268
Fax: 212 987 5593
Email: Charlotte.Cunningham-Rundles at mssm.edu
From: Soheil Chegini <schegini at yahoo.com<mailto:schegini at yahoo.com>>
Reply-To: "cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>" <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Date: Thursday, January 22, 2015 at 4:10 PM
To: "cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>" <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Subject: Re: [cis-pidd] Sub-protective pneumococcal titers in a CVID patient on therapeutic doses of IgSQ and recurrent bronchitis
His pre-Treatment IgG was 151.
________________________________
From: "Church, Joseph" <JChurch at chla.usc.edu<mailto:JChurch at chla.usc.edu>>
To: CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Sent: Thursday, January 22, 2015 3:24 PM
Subject: RE: [cis-pidd] Sub-protective pneumococcal titers in a CVID patient on therapeutic doses of IgSQ and recurrent bronchitis
What was the patient’s baseline IgG? If it was >400mg/dL he probably needs more Ig as the change from baseline to steady-state on SCIG would only be ~400mg/dL.
From: Soheil Chegini [mailto:schegini at yahoo.com]
Sent: Thursday, January 22, 2015 11:00 AM
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
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