Outcome of hypogammaglobulinemia in children: immunoglobulin levels as predictors.

We evaluated 131 children (M=88, F=43) with hypogammaglobulinemia. Data was analyzed mainly for delineating predictor factors for outcome. The distance from the lower limit of normal (-2SD) for any single measurement of immunoglobulins (Ig) was calculated and transformed into Ig scores. Mean age and duration of follow-up were 5.06 ± 4.05 and 3.7 ± 3.03 years, respectively. The diagnoses were: 22 CVID, 16 IgA deficiency, 33 transient hypogammaglobulinemia of childhood (THC), 3 selective IgM deficiency and 57 unclassified hypogammaglobulinemia (UCH). Low IgA scores (<-0.124) at presentation were indicative of subsequent development of IgA deficiency or CVID, whereas low IgM score (<-0.038) pointed towards more severe and persistent phenotypes. Combination of low IgM score between 2 and 5 years, impaired antibody response and low B cell counts enabled us to predict persistence of hypogammaglobulinemia beyond 5 years (specificity=90.5% and PPV=94.9%) and chronic lung disease (sensitivity=90.4% and specificity=68.3%). The set of criteria including low IgM scores, impaired antibody response and low B cell counts provided a high predictive value in detecting those with persistent hypogammaglobulinemia.

Immunologic aspects of sublingual immunotherapy in the treatment of allergy and asthma.

Recently interest has been focused on the administration of allergen specific immunotherapy by the oral route particularly sublingually. The mechanism by which sublingual immunotherapy exerts its effects remain unclear. Most likely, allergen captured within the oral mucosa by Langerhan's-like dendritic cells play a role in subsequent T cell responses. There is a growing body of evidence to support the role of regulatory T cells in controlling the development of allergic diseases. Nevertheless, there remains a lack of firm evidence that sublingual immunotherapy induces regulatory T cells. New vaccine developments with the increasing understanding of the molecular engineering techniques are on the way to offer the opportunity to design recombinant allergens that are safe, effective and easy to administer. In addition, the idea of using adjuvants along with allergen within the oral cavity is another promising approach.