Immunoglobulin deficiency and determination of pneumococcal antibody titers in patients with therapy-refractory recurrent rhinosinusitis

Abstract

We examined 245 patients with chronic rhinosinusitis not responding to prolonged antibiotic treatment and tested each patient for humoral antibody deficiencies. Low immunoglobulin levels were found in 22 patients. Five of them had defects of two or more immunoglobulin isotypes that were diagnosed as common variable immunodeficiency (CVI). Seventeen had an IgG-subclass deficiency. Before and after immunization with pneumococcal vaccine, serotype-specific pneumococcal antibody levels were determined to further evaluate the relevance of the underlying deficiency. Significantly reduced antibody titers of pneumococcal serotypes were found in CVI patients (n = 5), while immunization of 17 patients with IgG-subclass deficiency gave different results. Three of the 17 patients responded poorly to pneumococcal immunization and were prone to a polysaccharide specific immunodeficiency. Patients with CVI or IgG-subclass deficiency failing to produce protective antibody levels in more than five serotypes were chosen for antibiotic and/or immunoglobulin substitution therapy. Since recurrent sinusitis in these patients did not resolve with adequate conservative therapy, endonasal microsurgery was then performed and was seen to be a valuable therapeutic option. Our study suggests that an IgG-subclass deficiency may be the first sign of a basic immunological change, resulting in persisting sinus infections.

Clinical and Immunological Features of 65 Iranian Patients with Common Variable Immunodeficiency

“…A similar study done by Cunningham-Rundles and Bodian (17) showed that 243 out of 248 patients with CVID (98%) had recurrent sinusitis, otitis, or bronchitis, and according to another study in 1989 (18), 22% had developed chronic lung disease. Also, some studies show that resistant sinus infection can frequently be the first presenting symptom in immune deficiencies, especially antibody deficiencies (10,38,48), and the infections of the upper respiratory tract occur several years before the appearance of lower respiratory tract infections (34). Once the infections of the lower respiratory tract have started, the patients neglect the symptoms from the upper respiratory tract.…”

Antibody Deficiency in Chronic Rhinosinusitis: Epidemiology and Burden of Illness

“…A large proportion of CRS patients with IgG subclass deficien-cies also had abnormally low baseline pneumococcal titers, with several individuals failing to adequately respond to Pneumovax. 2,7,20,21 Although the aforementioned studies focused on IgG subclass deficiency and also described SAD in that context, there are very few studies that focus solely on the role of SAD in CRS. A recent retrospective study by Carr examined 129 patients with medically refractory CRS, requiring multiple surgeries.…”

“…The challenging task confronting clinicians is that the severity or intervals of disease do not point to an underlying cause. 7 In the case of immunodeficiency, the severity of CRS symptoms may not directly relate to an underlying immune dysfunction; however, an immunodeficiency may make disease more refractory to standard therapies. 8 This points to the importance of identifying the etiology of disease in a patient with refractory CRS, because treatment decisions can be significantly influenced.…”

“…One-half of the IgG subclassdeficient patients had abnormally low baseline pneumococcal titers and after Pneumovax vaccination, 3 of 17 had an inadequate response, and none of the CVID patients responded. 7 A retrospective analysis by Abrahamian looked at individuals with IgG3 deficiency and recurrent infections that were not limited to CRS and included pneumonia, fungal skin infections, recurrent herpes infections, and cystitis. 21 Six of 11 patients had low baseline pneumococcal titers, with 2 of the 6 failing to respond adequately to Pneumovax.…”

Bajo índice de sospecha para deficiencia de anticuerpos en niños sometidos a procedimientos quirúrgicos de Otorrinolaringología

“…May y su equipo, en Alemania, 1999, 16 encontraron niveles bajos de inmunoglobulinas en 22 de 245 pacientes con rinosinusitis crónica refractaria (17 deficiencia de subclases de IgG, 5 inmunodeficiencia común variable, 3 defecto Figura 6. IgE sérica total por edad en 16 pacientes pediátricos sometidos a cirugía de otorrinolaringología por infecciones respiratorias.…”