IgG anti-IgA antibodies in paediatric antibody-deficient patients receiving intravenous immunoglobulin

BACKGROUND: Immunoglobulin replacement therapy is an effective route of management for both infections and non-infectious complications in predominantly antibody deficiency (PAD). Trace levels of IgA (ranged from 0.4 to 2500 mg/ml), which exist in all immunoglobulin products, could lead to an increased susceptibility for adverse reactions in PAD patients. Furthermore, the exact mechanism which stimulates the anti-IgA antibody production in PAD is still unknown. The aim of this study was to evaluate IgG anti-IgA antibodies in PAD patients receiving intravenous immunoglobulin (IVIg) and its predisposing factors. METHODS: Available patients with confirmed diagnosis of PAD, who underwent regular IVIg replacement therapy in our centre, were enrolled in the study. Control group included 24 healthy individuals as the negative control and eight symptomatic patients with IgA deficiency as the positive control groups. IgG anti-IgA antibodies level was measured by the ELISA method. RESULTS: A significant difference was observed between Anti-IgA level of common variable immunodeficiency (CVID) and other PAD groups (p = 0.02). Moreover, six CVID patients were seropositive for the IgG anti-IgA antibody, with higher susceptibility to the adverse reactions (p < 0.001). IgG anti-IgA level has a negative relationship with serum IgA level (r = −0.06) and IVIg treatment duration (r = −0.006). CONCLUSION: Our data suggested that there was a significant association between anti-IgA antibody presence and the adverse reactions, especially in CVID patients with higher susceptibility to produce this constitutional antibody

No disponible

Autoimmunity in patients with selective IgA deficiency.

BACKGROUND AND OBJECTIVE: Selective immunoglobulin A deficiency (SIgAD) is the most common primary antibody deticiency. Patients with SIgAD have a greater risk of concomitant autoimmune disorders than healthy individuals. The exact mechanism underlying the relationship between autoimmunity and SIgAD is not fully understood. The aim of this study was to evaluate potential associations between autoimmunity and specific clinical or immunological findings in patients with SIgAD. METHODS: The study population comprised 57 symptomatic patients (65% males) with confirmed SIgAD who were referred to our center. Demographic data and history of autoimmunity were recorded both for patients and for their relatives. Comprehensive clinical and laboratory examinations were performed to investigate autoimmune complications in all the patients. RESULTS: Autoimmune disorders were documented in 17 cases (29.8%; 9 males and 8 females). The most common manifestations were thyroiditis, vitiligo, and hemolytic anemia (3 cases each). Ten patients (17.5%) had a family history of autoimmunity. Significant associations were detected between autoimmunity and increased duration of follow-up (P = .003), serum level of IgM (P = .01), regulatory T-cell count (P = .03), and class-switched memory B-cell count (P = .01). Four cases of autoimmune SIgAD (23.5%) progressed to common variable immunodeficiency during the follow-up period (P = .006). CONCLUSIONS: Autoimmune disorders, autoimmune cytopenia, and Ig subclass deficiency can lead to severe clinical manifestations in patients with SIgAD. Therefore, immunologists and pediatricians should be aware of these conditions.

IgG anti-IgA antibodies in paediatric antibody-deficient patients receiving intravenous immunoglobulin.

BACKGROUND: Immunoglobulin replacement therapy is an effective route of management for both infections and non-infectious complications in predominantly antibody deficiency (PAD). Trace levels of IgA (ranged from 0.4 to 2500 mg/ml), which exist in all immunoglobulin products, could lead to an increased susceptibility for adverse reactions in PAD patients. Furthermore, the exact mechanism which stimulates the anti-IgA antibody production in PAD is still unknown. The aim of this study was to evaluate IgG anti-IgA antibodies in PAD patients receiving intravenous immunoglobulin (IVIg) and its predisposing factors. METHODS: Available patients with confirmed diagnosis of PAD, who underwent regular IVIg replacement therapy in our centre, were enrolled in the study. Control group included 24 healthy individuals as the negative control and eight symptomatic patients with IgA deficiency as the positive control groups. IgG anti-IgA antibodies level was measured by the ELISA method. RESULTS: A significant difference was observed between Anti-IgA level of common variable immunodeficiency (CVID) and other PAD groups (p=0.02). Moreover, six CVID patients were seropositive for the IgG anti-IgA antibody, with higher susceptibility to the adverse reactions (p<0.001). IgG anti-IgA level has a negative relationship with serum IgA level (r=-0.06) and IVIg treatment duration (r=-0.006). CONCLUSION: Our data suggested that there was a significant association between anti-IgA antibody presence and the adverse reactions, especially in CVID patients with higher susceptibility to produce this constitutional antibody.

Autoimmunity in patients with selective IgA deficiency

Background and Objective: Selective immunoglobulin A deficiency (SIgAD) is the most common primary antibody deficiency. Patients with SIgAD have a greater risk of concomitant autoimmune disorders than healthy individuals. The exact mechanism underlying the relationship between autoimmunity and SIgAD is not fully understood. The aim of this study was to evaluate potential associations between autoimmunity and specific clinical or immunological findings in patients with SIgAD. Methods: The study population comprised 57 symptomatic patients (65% males) with confirmed SIgAD who were referred to our center. Demographic data and history of autoimmunity were recorded both for patients and for their relatives. Comprehensive clinical and laboratory examinations were performed to investigate autoimmune complications in all the patients. Results: Autoimmune disorders were documented in 17 cases (29.8%; 9 males and 8 females). The most common manifestations were thyroiditis, vitiligo, and hemolytic anemia (3 cases each). Ten patients (17.5%) had a family history of autoimmunity. Significant associations were detected between autoimmunity and increased duration of follow-up (P=.003), serum level of IgM (P=.01), regulatory T-cell count (P=.03), and class-switched memory B-cell count (P=.01). Four cases of autoimmune SIgAD (23.5%) progressed to common variable immunodeficiency during the follow-up period (P=.006). Conclusions: Autoimmune disorders, autoimmune cytopenia, and Ig subclass deficiency can lead to severe clinical manifestations in patients with SIgAD. Therefore, immunologists and pediatricians should be aware of these conditions (AU)

Fundamento y objetivo: La deficiencia selectiva de IgA (SIGAD) es la inmunodeficiencia primaria de anticuerpos más frecuente. Se conoce que los pacientes con SIGAD tienen un mayor riesgo de padecer trastornos autoinmunes asociados, en comparación con la población normal. Sin embargo, no se encuentra aún esclarecido el mecanismo exacto de la relación entre la autoinmunidad y el SIGAD. El objetivo de este estudio ha sido el evaluar las asociaciones entre la autoinmunidad y los hallazgos clínicos o inmunológicos en los pacientes con SIGAD. Métodos: Han sido estudiados cincuenta y siete pacientes sintomáticos (65% varones), con diagnóstico confirmado de SIGAD. Se registraron sus datos demográficos y los antecedentes, personales y familiares, de enfermedades autoinmunes, y se realizaron múltiples exámenes clínicos y de laboratorio. Resultados: Se documentaron enfermedades autoinmunes en 17 casos (29,8%; 9 hombres y 8 mujeres), siendo la tiroiditis, el vitíligo y la anemia hemolítica, las manifestaciones autoinmunes más comunes, con 3 casos para cada trastorno. Diez pacientes (17,5%) contaban con antecedentes familiares de autoinmunidad. Se encontraron asociaciones significativas con el desarrollo de enfermedades autoinmunes en estos pacientes con SIGAD: un prolongado período de seguimiento (p=0,003), el nivel sérico de IgM (p=0,01), la cuantificación de las linfocitos T reguladores (p=0,03) y el cambio de isotipo de los linfocitos B de memoria (p=0,01). Cuatro casos de SIGAD, con enfermedad autoinmune asociada (23,5%), evolucionaron hacia una inmunodeficiencia variable común, durante el período de seguimiento (p=0,006). Conclusiones: Los pacientes con SIGAD pueden desarrollar enfermedades autoinmunes que en ocasiones se manifiestan con formas clínicas graves y deben ser objeto de estudio y de seguimiento por parte del inmunólogo y del pediatra (AU)