Clinical Characteristics of Adults With Chronic Rhinosinusitis and Specific Antibody Deficiency

Sara Kashani, Tara F. Carr, Leslie C. Grammer, Robert P. Schleimer, Kathryn E. Hulse, Atsushi Kato, Robert C. Kern, David B. Conley, Rakesh K. Chandra, Bruce K. Tan, Anju T. Peters*

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Specific antibody deficiency (SAD) involves a deficient response to a polysaccharide vaccine in the setting of normal immunoglobulin G (IgG) levels and chronic infections. Patients with chronic rhinosinusitis (CRS) are often evaluated for SAD. There are limited data that describe patients with CRS and SAD. Objective: The objective of this study was to better characterize the role of SAD in CRS. Methods: We reviewed electronic records of adults with CRS who were evaluated for immunodeficiency with quantitative Ig levels and pre- and postantibody titers to a pneumococcal polysaccharide vaccine (PPV). Results: Fourteen pneumococcal serotypes were determined in 239 subjects from 2002 to 2009. Of these subjects, 64 had adequate protective titers of 1.3 μg/mL or higher in 7 or more serotypes of the 14 serotypes checked; 56 (23%) had less than 7 protective titers post-PPV and were diagnosed with SAD; and 119 had an adequate response to the vaccine with 7 or more serotypes being higher than 1.3 μg/mL (>50% response) and were characterized as "responders." Subjects with SAD received more antibiotic courses relative to responders in the 2 years after immunization (3.19 ± 2.64 vs 2.19 ± 2.24, P < .05). Of 56 subjects with SAD, 10 (17.9%) received Ig replacement therapy. Subjects who received Ig had fewer numbers of protective pneumococcal titers post-PPV and had more pneumonia (40.0%) versus subjects with SAD who did not receive Ig (10.9%). Conclusions: Of the 239 patients with CRS with normal IgG levels evaluated for immunodeficiency, 56 (23.4%) had SAD. A majority of patients with SAD may not need Ig replacement; however, a subset of patients with SAD benefit from Ig replacement.

Original languageEnglish (US)
Pages (from-to)236-242
Number of pages7
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume3
Issue number2
DOIs
StatePublished - Mar 1 2015

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Antibodies
Pneumococcal Vaccines
Vaccines
Immunoglobulin G
Polysaccharides
Immunization
Pneumonia
Anti-Bacterial Agents
Serogroup
Infection

Keywords

  • Chronic rhinosinusitis
  • Immunoglobulin replacement therapy
  • Pneumococcal antibody concentration
  • Primary immunodeficiency
  • Specific antibody deficiency

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

@article{7a12780c5e3f4141b0b62093de29c9de,
title = "Clinical Characteristics of Adults With Chronic Rhinosinusitis and Specific Antibody Deficiency",
abstract = "Background: Specific antibody deficiency (SAD) involves a deficient response to a polysaccharide vaccine in the setting of normal immunoglobulin G (IgG) levels and chronic infections. Patients with chronic rhinosinusitis (CRS) are often evaluated for SAD. There are limited data that describe patients with CRS and SAD. Objective: The objective of this study was to better characterize the role of SAD in CRS. Methods: We reviewed electronic records of adults with CRS who were evaluated for immunodeficiency with quantitative Ig levels and pre- and postantibody titers to a pneumococcal polysaccharide vaccine (PPV). Results: Fourteen pneumococcal serotypes were determined in 239 subjects from 2002 to 2009. Of these subjects, 64 had adequate protective titers of 1.3 μg/mL or higher in 7 or more serotypes of the 14 serotypes checked; 56 (23{\%}) had less than 7 protective titers post-PPV and were diagnosed with SAD; and 119 had an adequate response to the vaccine with 7 or more serotypes being higher than 1.3 μg/mL (>50{\%} response) and were characterized as {"}responders.{"} Subjects with SAD received more antibiotic courses relative to responders in the 2 years after immunization (3.19 ± 2.64 vs 2.19 ± 2.24, P < .05). Of 56 subjects with SAD, 10 (17.9{\%}) received Ig replacement therapy. Subjects who received Ig had fewer numbers of protective pneumococcal titers post-PPV and had more pneumonia (40.0{\%}) versus subjects with SAD who did not receive Ig (10.9{\%}). Conclusions: Of the 239 patients with CRS with normal IgG levels evaluated for immunodeficiency, 56 (23.4{\%}) had SAD. A majority of patients with SAD may not need Ig replacement; however, a subset of patients with SAD benefit from Ig replacement.",
keywords = "Chronic rhinosinusitis, Immunoglobulin replacement therapy, Pneumococcal antibody concentration, Primary immunodeficiency, Specific antibody deficiency",
author = "Sara Kashani and Carr, {Tara F.} and Grammer, {Leslie C.} and Schleimer, {Robert P.} and Hulse, {Kathryn E.} and Atsushi Kato and Kern, {Robert C.} and Conley, {David B.} and Chandra, {Rakesh K.} and Tan, {Bruce K.} and Peters, {Anju T.}",
year = "2015",
month = "3",
day = "1",
doi = "10.1016/j.jaip.2014.09.022",
language = "English (US)",
volume = "3",
pages = "236--242",
journal = "Journal of Allergy and Clinical Immunology: In Practice",
issn = "2213-2198",
publisher = "Elsevier",
number = "2",

}

TY - JOUR

T1 - Clinical Characteristics of Adults With Chronic Rhinosinusitis and Specific Antibody Deficiency

AU - Kashani, Sara

AU - Carr, Tara F.

AU - Grammer, Leslie C.

AU - Schleimer, Robert P.

AU - Hulse, Kathryn E.

AU - Kato, Atsushi

AU - Kern, Robert C.

AU - Conley, David B.

AU - Chandra, Rakesh K.

AU - Tan, Bruce K.

AU - Peters, Anju T.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Background: Specific antibody deficiency (SAD) involves a deficient response to a polysaccharide vaccine in the setting of normal immunoglobulin G (IgG) levels and chronic infections. Patients with chronic rhinosinusitis (CRS) are often evaluated for SAD. There are limited data that describe patients with CRS and SAD. Objective: The objective of this study was to better characterize the role of SAD in CRS. Methods: We reviewed electronic records of adults with CRS who were evaluated for immunodeficiency with quantitative Ig levels and pre- and postantibody titers to a pneumococcal polysaccharide vaccine (PPV). Results: Fourteen pneumococcal serotypes were determined in 239 subjects from 2002 to 2009. Of these subjects, 64 had adequate protective titers of 1.3 μg/mL or higher in 7 or more serotypes of the 14 serotypes checked; 56 (23%) had less than 7 protective titers post-PPV and were diagnosed with SAD; and 119 had an adequate response to the vaccine with 7 or more serotypes being higher than 1.3 μg/mL (>50% response) and were characterized as "responders." Subjects with SAD received more antibiotic courses relative to responders in the 2 years after immunization (3.19 ± 2.64 vs 2.19 ± 2.24, P < .05). Of 56 subjects with SAD, 10 (17.9%) received Ig replacement therapy. Subjects who received Ig had fewer numbers of protective pneumococcal titers post-PPV and had more pneumonia (40.0%) versus subjects with SAD who did not receive Ig (10.9%). Conclusions: Of the 239 patients with CRS with normal IgG levels evaluated for immunodeficiency, 56 (23.4%) had SAD. A majority of patients with SAD may not need Ig replacement; however, a subset of patients with SAD benefit from Ig replacement.

AB - Background: Specific antibody deficiency (SAD) involves a deficient response to a polysaccharide vaccine in the setting of normal immunoglobulin G (IgG) levels and chronic infections. Patients with chronic rhinosinusitis (CRS) are often evaluated for SAD. There are limited data that describe patients with CRS and SAD. Objective: The objective of this study was to better characterize the role of SAD in CRS. Methods: We reviewed electronic records of adults with CRS who were evaluated for immunodeficiency with quantitative Ig levels and pre- and postantibody titers to a pneumococcal polysaccharide vaccine (PPV). Results: Fourteen pneumococcal serotypes were determined in 239 subjects from 2002 to 2009. Of these subjects, 64 had adequate protective titers of 1.3 μg/mL or higher in 7 or more serotypes of the 14 serotypes checked; 56 (23%) had less than 7 protective titers post-PPV and were diagnosed with SAD; and 119 had an adequate response to the vaccine with 7 or more serotypes being higher than 1.3 μg/mL (>50% response) and were characterized as "responders." Subjects with SAD received more antibiotic courses relative to responders in the 2 years after immunization (3.19 ± 2.64 vs 2.19 ± 2.24, P < .05). Of 56 subjects with SAD, 10 (17.9%) received Ig replacement therapy. Subjects who received Ig had fewer numbers of protective pneumococcal titers post-PPV and had more pneumonia (40.0%) versus subjects with SAD who did not receive Ig (10.9%). Conclusions: Of the 239 patients with CRS with normal IgG levels evaluated for immunodeficiency, 56 (23.4%) had SAD. A majority of patients with SAD may not need Ig replacement; however, a subset of patients with SAD benefit from Ig replacement.

KW - Chronic rhinosinusitis

KW - Immunoglobulin replacement therapy

KW - Pneumococcal antibody concentration

KW - Primary immunodeficiency

KW - Specific antibody deficiency

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