[CIS PIDD] [cis-pidd] Selective Antibody Deficiency

Thu Jan 26 09:35:26 EST 2017

While I agree with you  Tony that it would be good to reach a consensus, I insists that we need to leave open the possibility that patients with well documented infections may have only mild or no SPAD but have significant improvement on IgG replacement. It is a bit presumptuous to assume that our testing of specific  antibodies is so perfect that we have to use the numeric test results to dictate who deserves or does not deserve at least well controlled  therapeutic trial.

I understand that there are no published papers documenting this – I am working on a study and eventual publication to make to point. In the meantime, I insist that defining our patients problems based on a few number ignores the uniqueness and special needs of individual patients.

Best regards,

Ricardo

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Wednesday, January 25, 2017 2:29 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] Selective Antibody Deficiency

*EXTERNAL EMAIL: EVALUATE*
The key problem is designing a study with a reasonable cost that has some reasonable likelihood of a meaningful, believable outcome.
Richard Wasserman

On Wed, Jan 25, 2017 at 2:20 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> wrote:
Hi Ricardo,

While I realize that there is a great deal of controversy regarding SAD, mild phenotype, now that both the Clinical Immunology and Primary Immunodeficiency Committees of the Academy have opined on it, I hope that there will be a trend by allergists/immunologists toward recognizing that there are a few of these patients for whom Ig replacement might be indicated as a trial once all other reasonable treatments have been exhausted. I have a few patients who have benefited, but most cannot get insurance approval.  If more immunologists were in agreement, we would have more success in treating these most difficult patients..

I hope that others will opine.

Tony

Wellington S. Tichenor, MD, FACP, FAAAI
642 Park Avenue
New York, New York 10065
212 517-6611<tel:(212)%20517-6611>
wtichenor at sinuses.com<https://register.concentric.com/home/apps/mail/mbox_compose.cgi?pTo=wtichenor@sinuses.com>

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________________________________
From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>]
Sent: Friday, January 20, 2017 9:23 AM
To: CIS-PIDD
Subject: RE: [cis-pidd] Selective Antibody Deficiency
Hi Wellington, I am sorry to be a pest but nobody here; myself and librariansat Children’s Hospital and LSU  can get tis page to open. I hear the same problem form other sources.
Any suggestion, or can you send me an informal copy?
I am updating the UpToDate chapter on this issue and want to be sure to be in sink with the AAAAI latest recommendations.

Best,
Ricardo Sorensen

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>]
Sent: Thursday, January 19, 2017 12:20 PM
To: CIS-PIDD
Subject: RE: [cis-pidd] Selective Antibody Deficiency

*EXTERNAL EMAIL: EVALUATE*
It took about 30 seconds to open for me.
________________________________
From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>]
Sent: Thursday, January 19, 2017 12:59 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] Selective Antibody Deficiency
doesnt open.

2017-01-19 15:04 GMT-02:00 CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>:
It is the update and can be found at:  http://www.jacionline.org/article/S0091-6749(16)31141-1/fulltext.

Sincerely,

Wellington S. Tichenor, M. D.
642 Park Avenue
New York, New York 10065
212 517-6611<tel:(212)%20517-6611>
wtichenor at sinuses.com<https://register.concentric.com/home/apps/mail/mbox_compose.cgi?pTo=wtichenor@sinuses.com>

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Thank you.

________________________________
From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>]
Sent: Thursday, January 19, 2017 11:27 AM
To: CIS-PIDD
Subject: RE:[cis-pidd] Selective Antibody Deficiency
Is this review different from the update of the uses of human immunoglobulins, also to appear in JACI this year?
If different , could you give some details about how to find it?
Ricardo Sorensen

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>]
Sent: Tuesday, January 17, 2017 8:01 PM
To: CIS-PIDD
Subject: [cis-pidd] Selective Antibody Deficiency

*EXTERNAL EMAIL: EVALUATE*
In  2012, the Clinical Immunology Committee of the AAAAI issued a working group report published in JACI reclassifying selective antibody deficiency into 4 groups, including a mild category, defined as a lack of response to 2 or more of the serotypes in the Pneumovax vaccine.  They also stated that treatment with replacement Ig might be warranted.

The Primary Immunodeficiency Committee of the AAAAI has just published a work group report reiterating the same recommendation.  That report is currently available online and will be published in JACI in March 2017.  With both groups in agreement regarding the potential use of Ig in patients with this diagnosis, is there now a consensus that treatment may be appropriate in some patients with the mild phenotype?

I recognize that until now, many disagreed with that original suggestion.  I primarily treat patients with chronic rhinosinusitis which is resistant to all treatments including multiple surgeries, culture directed antibiotics, omalizumab, etc.  I have had several patients with SAD mild phenotype who received a trial of Ig and have responded well to therapy.  While there may be a limited number of patients who require this treatment, it can be very beneficial.

I would appreciate the groups thoughts on this since many insurance companies still refuse to authorize treatment under the above circumstances.
Sincerely,

Wellington S. Tichenor, MD, FACP, FAAAI
642 Park Avenue
New York, New York 10065
212 517-6611<tel:(212)%20517-6611>
wtichenor at sinuses.com<https://register.concentric.com/home/apps/mail/mbox_compose.cgi?pTo=wtichenor@sinuses.com>

NOTICE OF CONFIDENTIALITY
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the sender immediately by telephone so arrangements may be made to return the documents or destroy them.  Use, disclosure, distribution or copying of
documents transmitted to you in error is strictly prohibited.  HIPAA regulations suggest that you use encrypted email to send any protected health information.
Thank you.

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Leonardo Oliveira Mendonça
Médico Especialista em Imunologia Clínica e Alergia, Doenças Autoimunes e Autoinflamatórias
Médico Especialista em Clínica Médica/Medicina Interna

Leonardo Oliveira Mendonça, MD
Specialist in Clinical Immunology and Allergy, Autoimmune and Autoinflammatory disorders
Consultant Specialist in Internal Medicine

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Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
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