Allergic and immunologic parameters in patients with Fanconi's anemia

Background: Fanconi's anemia (FA) is a rare recessive chromosomal instability disorder, characterized by progressive bone marrow failure and congenital defects. Patients with FA present with recurrent infections, particularly those of the respiratory tract. Objective: the aim of the present study was to evaluate whether patients with FA have altered antibody-mediated immune responses. Methods: A group of 12 patients with FA, 5-32 years old (6 males) was studied. Serum levels of IgG, IgM, IgA and IgG subclasses, isohemagglutinin titers and specific IgG antibodies to poliovirus and measles were determined using standard methods. Immediate skin tests to common inhalant allergens were performed, and total and specific serum IgE was quantitated using a fluoroenzymatic assay (Uni-CAP, Pharmacia). Antipneumococcal antibodies were measured by ELISA before and 4-8 weeks after immunization with pneumococcal vaccine (Pneumo 23, Pasteur Merieux Connaught). Responses to serotypes 1, 3, 5, 6B, 9V and 14, which are the most prevalent in our country, were studied. Results: Ten patients had elevated IgE levels in sera, and 7 of them had detectable specific IgE and positive immediate skin tests. An inadequate response to pneumococcal vaccination was found in 2 of the 12 patients. Isohemagglutinin titers and levels of IgG, IgM, IgA and IgG subclasses and antipoliovirus and antimeasles antibodies were within the normal limits for age in all patients. Two patients had undetectable IgG4 levels (below 5 mg/dl). Conclusions: the results indicate that a proportion of patients with FA (2/12) in our study had inadequate responses to pneumococcal vaccination. No other significant abnormalities of the immune system were found in these patients. Copyright (C) 2001 S. Karger AG, Basel.Univ São Paulo, Sch Med, Dept Pediat, BR-14049900 Ribeirao Preto, SP, BrazilUniv São Paulo, Sch Med, Dept Cell & Mol Biol, BR-14049900 Ribeirao Preto, SP, BrazilUniv São Paulo, Inst Ciencias Biomed, Dept Immunol, BR-05508 São Paulo, BrazilWeb of Scienc

BCG and live virus vaccines in patients with primary immunodeficiency (PID) diagnosis, report on 155 patients

Universidade Federal de São Paulo, EPM, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, São Paulo, BrazilUniv São Paulo, Dept Immunol ICB 2, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, EPM, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, São Paulo, BrazilWeb of Scienc

Increases in serum immunoglobulins to age-related normal levels in children with IgA and/or IgG subclass deficiency

WOS: 000244554100013PubMed ID: 17338791Immunoglobulins (Ig) A and G subclass deficiencies are common immune system disorders which cause morbidity especially between 2 and 6 yr of age. Prognosis of these defects and therapeutic approach is unclear. The aim of the present retrospective study was to review the clinical and laboratory records of 87 children with IgA and/or IgG subclass deficiency to determine whether these patients experience changes in serum Ig concentrations during follow-up and to give more clinic and laboratory information to the families about the course of these diseases. Among 87 patients studied, the most frequent defect was partial IgA deficiency combined with IgG3 subclass deficiency (41%). The other groups were as follows; partial IgA deficiency (32%), selective IgA deficiency (8%), partial IgA combined with IgG2-G4 subclass deficiency (6%), and IgG subclass deficiency (13%). The commonest clinical presentations were recurrent upper respiratory tract infections (76%), pneumonia (14%), acute gastroenteritis (3%), urinary tractus infection (3%), sinusitis (2%), and acute otitis media (2%). Atopy was widely represented in the patients studied (24%). The number of patients who were given prophylactic treatment with benzathine penicilline, prophylactic oral antibiotic, or oral bacterial extract to prevent infections was 68 (78%). Frequency of recurrent infections decreased from 7.9 +/- 4.9 per year to 2.5 +/- 2.3 in 68 patients receiving any prophylactic regimen; however, decrease in frequency of infections did not show any significant difference between different prophylactic groups. None of the patients in the selective IgA deficiency group had reached normal serum levels of IgA. At the age of 58.3 +/- 21.4 months, 52% of patients in partial IgA deficiency group and 51% of patients in partial IgA + IgG subclass deficiency group, serum IgA increased to normal ranges. Serum IgG subclass levels increased to normal range for age in 67% of patients in partial IgA + IgG subclass deficiency group and in 30% of patients in isolated IgG subclass deficiency group. The mean age for reaching age-related normal IgG subclass levels for these patients was 69.0 +/- 14.5 months. In conclusion, findings of this study suggest that IgA and/or IgG subclass deficiency may be either progressive or reversible disorders and emphasize the value of monitoring Ig levels in affected individuals

Evaluation of pneumococcal immunization in patients with recurrent infections and asthma

Louisiana State Univ, Dept Pediat, New Orleans, LA USAUniv São Paulo, ICB, Dept Immunol, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, EPM, Rheumatol Dept Pediat, Div Allergy Clin Immunol Rheumatol, São Paulo, BrazilUniversidade Federal de São Paulo, EPM, Rheumatol Dept Pediat, Div Allergy Clin Immunol Rheumatol, São Paulo, BrazilWeb of Scienc

Chronic granulomatous disease in Latin American patients: Clinical spectrum and molecular genetics

Background. Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by early onset of recurrent and severe infections. The molecular defects causing CGD are heterogeneous and lead to absence, low expression, or malfunctioning of one of the phagocyte NADPH oxidase components. The aim of this study was to analyze the clinical features and to investigate the molecular genetic defects of Latin American patients with CGD. Procedures. The study included 14 patients. The diagnosis was based on a history of recurrent severe infections, impaired respiratory burst, and the demonstration of an underlying mutation by single strand conformation polymorphism (SSCP) or RT-PCR analysis, followed by genomic DNA or cDNA sequencing. Results. Seven unrelated patients were found to have the X-linked form of CGD (X-CGD). Heterogeneous mutations affected the CYBB gene: two insertions, one substitution, and four splice site defects; two of them are novel. Seven patients presented with one of the autosomal recessive forms of CGD (A47-CGD); all had the most common mutation, a Delta GT deletion in exon 2 of the NCF1 gene. Pneumonia was the most frequent clinical feature, followed by pyoderma, sinusitis, otitis, and liver abscess. Patients with X-CGD were more likely to have initial infections before age 2 years and to have inflammatory obstructive granulomas later. None of the patients had severe adverse reactions to BCG immunization. Conclusions. X-CGD patients from Latin America showed a high degree of molecular heterogeneity, including two novel Mutations. Their clinical characteristics included early onset of infections and eventual obstructive granulomas. A47-CGD represented 50% of the reported cases, a higher prevalence than reported in other series.46224325