[CIS PIDD] [cis-pidd] varicella vaccine prior to IGIV
CIS-PIDD
cis-pidd at lists.clinimmsoc.org
Wed May 10 22:46:11 EDT 2017
Prescott,
SPEP and IEP showed no evidence of clonality. Did not do flow on T cells.
Richard
On Wed, May 10, 2017 at 8:11 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
wrote:
> Richard – I agree with Joe: I've recommended against such antibody
> deficiency patients receiving VZV vaccines. While I’m aware of several
> examples of “getting away with it”, I’ve taken the conservative approach of
> avoiding any risk of inducing complications given the questionable benefit
> in this population. Also not trivial is the clear contraindication listed
> in the package inserts.
>
> Marc
>
> 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 <(858)%20657-5350> Fax 858.657.5375 <(858)%20657-5375>
>
>
> From: <cis-pidd at lyris.dundee.net> on behalf of CIS-PIDD <
> cis-pidd at lists.clinimmsoc.org>
> Reply-To: CIS-PIDD <cis-pidd at lyris.dundee.net>
> Date: Wednesday, May 10, 2017 at 4:06 PM
> To: CIS-PIDD <cis-pidd at lyris.dundee.net>
> Subject: RE: [cis-pidd] varicella vaccine prior to IGIV
>
> Richard:
>
>
>
> I agree that he is unlikely to respond with effective antibody responses.
> Specifically he has low total IgG and IgG to VZV despite getting a higher
> dose VZV vaccine in Zostavax versus Varivax, and his switched memory
> B-cells are close to nil.
>
>
>
> Although he could have Valtrex available should he break out after the
> vaccine, why take any risk?
>
>
>
> Joe Church
>
>
>
> *From:* cis-pidd at lyris.dundee.net [mailto:cis-pidd at lyris.dundee.net
> <cis-pidd at lyris.dundee.net>] *On Behalf Of *CIS-PIDD
> *Sent:* Wednesday, May 10, 2017 2:25 PM
> *To:* CIS-PIDD
> *Subject:* [cis-pidd] varicella vaccine prior to IGIV (EXTERNAL EMAIL)
>
>
>
> I am seeing a 63yo pediatric ophthalmologist who was treated for mantle
> cell lymphoma with an aggressive regimen including retuximab five years
> ago. Had medullary thyroid cancer 15 years ago and has had recurrent
> disease.
>
>
>
> He was treated wit IGIV for about two years after his lymphoma diagnosis
> but then therapy was stopped. He has recurrent respiratory tract infections
> but no pneumonias, mostly sinusitis. Because of his recurrent infections
> and lab studies, he is willing to resume his IGIV therapy. Despite my
> discussion, he believes that his abnormalities of humoral immunity will be
> transitory and therefore he wants to be immunized prior to restarting IGIV.
> He wants varicella vaccine (see lab) and I am reluctant to give him a live
> virus vaccine. He received Zostvax about 2-3 years ago without difficulty.
> He also wants Prevnar and dTap despite my suggestion that he is unlikely to
> respond well. I have no problem giving those vaccines. By the way, the
> elevated IgM is not clonal at the protein level.
>
>
>
> Would you give him varicella vaccine?
>
> Thank you,
>
> Richard Wasserman
>
> Dallas
>
>
>
>
>
> *Immunoglobulin G, Qn, Serum*
>
> * [L] 236 mg/dL 700-1600 *
>
> *Immunoglobulin A, Qn, Serum (001784)*
>
> * Immunoglobulin A, Qn, Serum*
>
> * [L] 46 mg/dL 61-437*
>
>
>
> *Immunoglobulin M, Qn, Serum (001792)*
>
> * Immunoglobulin M, Qn, Serum*
>
> * [H] 522 mg/dL 20-172*
>
>
>
> Tests: (6) Varicella-Zoster V Ab, IgG (096206)
>
> Varicella Zoster IgG [L] 137 index Immune >165
>
> A second sample should be collected and tested no less than 2-4 weeks.
>
> Negative <135
>
> Equivocal 135 - 165
>
> Positive >165
>
> A positive result generally indicates exposure to the
>
> pathogen or administration of specific immunoglobulins,
>
> but it is not indication of active infection or stage
>
> of disease.
>
>
>
>
>
>
>
> Tests: (2) Pneumococcal Ab (23 Serotype) (812166)
>
> Pneumo Ab Type 1* [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 3* [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 4* [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 8* [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 9 (9N)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 12 (12F)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 14* [L] 0.6 ug/mL >1.3
>
> ! Pneumo Ab Type 17 (17F)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 19 (19F)*
>
> [L] <0.3 ug/mL >1.3
>
> ! Pneumo Ab Type 2* [L] <0.3 ug/mL >1.3
>
> ! Pneumo Ab Type 20* [L] <0.3 ug/mL >1.3
>
> ! Pneumo Ab Type 22 (22F)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 23 (23F)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 26 (6B)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 34 (10A)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 43 (11A)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 5* [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 51 (7F)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 54 (15B)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 56 (18C)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 57 (19A)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 68 (9V)*
>
> [L] <0.3 ug/mL >1.3
>
> Pneumo Ab Type 70 (33F)*
>
> [L] 0.4 ug/mL >1.3
>
>
>
> WBC 8.5 x10E3/uL 3.4-10.8
>
> RBC 5.25 x10E6/uL 4.14-5.80
>
> Hemoglobin 15.1 g/dL 12.6-17.7
>
> Hematocrit 45.4 % 37.5-51.0
>
> MCV 87 fL 79-97
>
> MCH 28.8 pg 26.6-33.0
>
> MCHC 33.3 g/dL 31.5-35.7
>
> RDW 13.7 % 12.3-15.4
>
> Platelets 246 x10E3/uL 150-379
>
> Neutrophils 63 %
>
> Lymphs 23 %
>
> Monocytes 10 %
>
> Eos 3 %
>
> Basos 1 %
>
> Neutrophils (Absolute)
>
> 5.4 x10E3/uL 1.4-7.0
>
> Lymphs (Absolute) 2.0 x10E3/uL 0.7-3.1
>
> Monocytes(Absolute) 0.9 x10E3/uL 0.1-0.9
>
> Eos (Absolute) 0.3 x10E3/uL 0.0-0.4
>
> Baso (Absolute) 0.1 x10E3/uL 0.0-0.2
>
> Immature Granulocytes
>
> 0 %
>
> Immature Grans (Abs) 0.0 x10E3/uL 0.0-0.1
>
>
>
>
>
> Tests: (3) B-Cell Memory and Naive Panel (818314)
>
> ! B-cells % CD19 24 % 5-26
>
> ! B-cells Absolute CD19
>
> 466 cells/uL 58-558
>
> ! Naive B-cell %CD19+/CD27-/IgD+
>
> 82 % 29-93
>
> ! Naive BCL Abs CD19+/CD27-/IgD+
>
> 384 cells/uL 22-423
>
> ! Non-switched Memory %
>
> 10 % 2-25
>
> ! Non-switch Abs 47 cells/uL 4-66
>
> ! Class-switched Memory %
>
> [L] <1 % 3-23
>
> ! Class-switched Abs [L] 2 cells/uL 4-62
>
> ! IgM Only Memory % 1.3 % .3-6.0
>
> ! IgM Only Memory Abs 6.1 cells/uL .6-16.4
>
> ! Total Memory B-cell%CD19/CD27+
>
> 12 % 7-48
>
> ! Tot Mem BCL Absol CD19+/CD27+
>
> 56 cells/uL 13-148
>
> INTERPRETIVE INFORMATION: B-Cell Memory and Naive Panel
>
> This panel is indicated for patients with suspected immune
>
> deficiencies, especially Common Variable Immune Deficiency (CVID),
>
> and to assess reconstitution of B-cell subsets after bone marrow
>
> or stem cell transplant. Subsets measured: B-cells (CD19+), total
>
> memory B-cells (CD19+ CD27+), class switched memory B-cells (CD19+
>
> CD27+ IgD- IgM-), non-switched/marginal zone memory B-cells (CD19+
>
> CD27+ IgD+ IgM+), IgM only memory B-cells (CD19+ CD27+ IgD-IgM+),
>
> and naive B-cells (CD19+ CD27-IgD+).
>
> Test developed and characteristics determined by ARUP
>
> Laboratories. See Compliance Statement A: aruplab.com/CS
>
>
>
>
>
> Tests: (5) Rubella Antibodies, IgG (006197)
>
> Rubella Antibodies, IgG
>
> 3.32 index Immune >0.99
>
> Non-immune <0.90
>
> Equivocal 0.90 - 0.99
>
> Immune >0.99
>
>
>
> Tests: (7) Rubeola Antibodies, IgG (096560)
>
> Rubeola Ab, IgG 181.0 AU/mL Immune >29.9
>
> Negative <25.0
>
> Equivocal 25.0 - 29.9
>
> Positive >29.9
>
> Presence of antibodies to Rubeola is presumptive evidence
>
> of immunity except when acute infection is suspected.
>
>
>
>
>
> Tests: (8) Haemophilus influenzae B IgG (138271)
>
> Haemophilus influenzae B IgG
>
> 0.16 ug/mL
>
> NOTE: An anti-Hib level of 0.15 ug/mL is generally accepted as the
>
> minimum level for protection. Optimal protection post-vaccination
>
> requires a level greater than 1.00 ug/mL.
>
>
>
>
>
> Tests: (9) Tetanus Antitoxoid IgG Ab (163691)
>
> Tetanus Antitoxoid IgG Ab
>
> 0.42 IU/mL <0.10
>
> Interpretation:
>
> Non-Protective <0.10
>
> Protective >=0.10
>
> Results for this test are for research purposes
>
> only by the assay's manufacturer. The performance
>
> characteristics of this product have not been
>
> established. Results should not be used as a
>
> diagnostic procedure without confirmation of the
>
> diagnosis by another medically established diagnostic
>
> product or procedure.
>
>
>
>
>
> Tests: (10) Diphtheria Antitoxoid Ab (163709)
>
> Diphtheria Antitoxoid Ab
>
> [L] <0.10 IU/mL <0.10
>
> Interpretation:
>
> Non-Protective <0.10
>
> Protective >=0.10
>
> For research use only.
>
>
>
>
>
> Tests: (11) TgAb+Thyroglobulin,IMA or RIA (042060)
>
> ! Thyroglobulin Antibody
>
> 0.1 IU/mL 0.0-0.9
>
> Thyroglobulin Antibody measured by Beckman Coulter Methodology
>
>
>
>
>
> Tests: (12) Thyroglobulin by IMA (006705)
>
> ! Thyroglobulin by IMA [H] 454.0 ng/mL 1.4-29.2
>
> According to the National Academy of Clinical Biochemistry, the
>
> reference interval for Thyroglobulin (TG) should be related to
>
> euthyroid patients and not for patients who underwent thyroidectomy.
>
> TG reference intervals for these patients depend on the residual
>
> mass of the thyroid tissue left after surgery. Establishing a
>
> post-operative baseline is recommended.
>
> The assay limit of quantitation is 0.1 ng/mL
>
> Thyroglobulin measured by Beckman Coulter Immunometric Assay
>
>
>
> --
>
> 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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--
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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