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

Tue Aug 4 18:31:10 EDT 2015

agree. same in kids.

From: Riedl, Marc [mailto:mriedl at ucsd.edu]
Sent: Tuesday, August 04, 2015 1:56 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] poor antigen responsiveness

Richard,

I see this pattern not infrequently in adults undergoing immunologic evaluation (normal mitogen with absent antigen LPA responses), often with otherwise entirely normal antibody levels and function.  I don't know what to make of it and have become less enamored with even measuring LPA unless there's a very strong clinical history of problematic fungal or recalcitrant viral infections.  There may be some different nuances in kids, but I typically have tried to "explain this away" in adults since there's no specific intervention and I've not seen any complications in following these folks over the years.

Marc Riedl, MD, MS
Professor of Medicine
Adult Primary Immunodeficiency Program
Division of Rheumatology, Allergy & Immunology
University of California, San Diego
8899 University Center Lane, Suite 230
San Diego, CA  92122
Tel 858.657.5350  Fax 858.657.5375

From: Richard Wasserman <drrichwasserman at gmail.com<mailto:drrichwasserman at gmail.com>>
Reply-To: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Date: Tuesday, August 4, 2015 at 11:21 AM
To: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
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?
[Image removed by sender.]

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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