[CIS PIDD] [cis-pidd] poor antigen responsiveness

[Kobrynski, Lisa]

The lack of response to in vitro stimulation with candida is not surprising.  Most children do not have good proliferation to candida.  The proliferative response to tetanus really depends on how long ago he received his booster.  Several years after immunization the proportion of antigen specific T cells that are recoverable in the peripheral blood is very small, so in vitro stimulation of PBMC may not show much response.



I would be most interested to know if he still has antibody to Tetanus and if he had a normal proportion of memory switched B cells.





Lisa Kobrynski, MD, MPH
Associate Professor of Pediatrics
Marcus Professor of Immunology
Section, Allergy/Immunology
________________________________
From: Richard Wasserman [drrichwasserman at gmail.com]
Sent: Tuesday, August 04, 2015 2:21 PM
To: CIS-PIDD
Subject: [cis-pidd] poor antigen responsiveness

Several years ago I picked up a child who had been evaluated by a non-immunologist at age two. Immunoglobulins and T cell numbers were marginal. He was maintained on immunoglobulin, anti-bacterial and anti-fungal prophylaxis with only a modest history of infections. I discontinued all treatments over a year and he has done well for the subsequent five years with no significant infections. Simple URIs do not have a prolonged recovery.

Three years ago immunoglobulins and vaccine responses were normal as were CD 3,4,8,16/56 and 19. Mitogen responses were normal. There was no response in vitro to candida or tetanus. Reevaluation (without remeasuring specific antibodies) was the same with normal lymphocyte numbers and mitogen responses but no detectable response to tetanus or candida.

I plan to just follow him and reevaluate in a few years. Any other suggestions?
[https://ssl.gstatic.com/ui/v1/icons/mail/images/cleardot.gif]

Richard Wasserman
Dallas

--
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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