Immunoglobulins in Otitis-Prone Children

Abstract

Defective or immature antibody responses to pathogens in children may explain the increased susceptibility to acute otitis media (AOM) in otitis-prone children. In literature, data on immunology have been based on studies of small groups of severely otitis-prone children and have not been consistent. Humoral immune status was assessed in 365 children, 1-7 years old, with two or more documented episodes of AOM in the previous year. Children with 4 or more episodes in the preceding year were defined as otitis-prone. Serum immunoglobulin levels were determined by radial immunodiffusion. Immunoglobulin levels of otitis-prone children were compared with those of children who had experienced 2-3 AOM episodes per year. Children with recurrent episodes of AOM were found to have normal or increased serum IgA, IgM, IgG, and IgG1 levels compared with normal values for age, whereas the serum IgG2 levels were mostly in the lower normal range. Twenty-two percent of all children showed IgG2 levels lower than 2 SD below the age-specific mean. Interestingly, the otitis-prone group of children showed significantly lower median and mean levels for all immunoglobulins compared with those children with only 2-3 previous AOM episodes. Lower immunoglobulin levels in otitis-prone children suggest a generalized decreased antibody response in otitis-prone children. Based on the clinical observation that some children experience recurrent episodes of acute otitis media (AOM), the term "otitis-prone" was introduced by Howie (1). In general, the otitis-prone condition is defined as three or more episodes of AOM in 6 mo or four or more episodes in 12 mo; up to 5% of all children comply with this definition (2, 3).With respect to immunoglobulin serum levels, both normal as well as stimulated serum IgA, IgM, IgG, and IgG1 levels have been reported in otitis-prone children aged 2 mo or older (4, 5). Freijd et al. and Sørensen et al. reported lower levels of IgG2 in children with recurrent AOM compared with agematched controls (5, 6), but others did not confirm these observations (4, 7).With respect to antibody activity against the two main bacterial pathogens in AOM Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHI), subnormal or absent antibody responses have been reported in otitis-prone children (8 -11), as well as decreased antibody responses upon immunization with Hib conjugate and rubella vaccine (12, 13).These findings may suggest decreased antibody responses upon both T cell-dependent as well as T cell independent antigens in otitis-prone children (14). Hitherto, immunologic evaluations have been performed only in small groups of otitis-prone children. The need to obtain more substantial data led us to analyze immunoglobulins in a large group of 365 children with varying susceptibility to acute otitis media. METHODSThis study was conducted in a general hospital (Spaarne Hospital Haarlem) and a tertiary care hospital (University Medical Center Utrecht), the Netherlands. The Medical Ethics Committees of both participa...

Comparative Analysis of the Humoral Immune Response to Moraxella catarrhalis and Streptococcus pneumoniae Surface Antigens in Children Suffering from Recurrent Acute Otitis Media and Chronic Otitis Media with Effusion

“…The immune response to pathogens develops rapidly during the first few years of life, as children become exposed to an increasing number of microbial species and strains. The high incidence and high rate of spontaneous recovery from OM suggests that recovery is a natural phenomenon and part of the gradual maturation of the child's immune system, though a defective or immature antibody response to OM pathogens may explain the increased susceptibility of some children to OM (36). Differences in the presence/absence and levels of pathogenspecific IgG and IgM at particular body sites may be one of the mechanisms by which OM pathogens are able to facilitate the development of OM disease.…”

Infectious and Noninfectious Pulmonary Complications in Patients With Primary Immunodeficiency Disorders

“…Infection is more severe in patients with a defect in polysaccharide antibody production associated with IgG subclass deficiency and SIgAD [42][43][44]. IgG2 may protect against polysaccharides, because it has been indicated that patients with low IgG2 had recurrent episodes of otitis media despite exhibiting normal levels of IgA, IgM, IgG and IgG1 [45]. Sinopulmonary complications such as otitis media are more common in PAD than in combined immunodeficiency …”

Expression of Toll-like Receptors 2 and 4 and Immunoglobulins in Children wih Recurrent Otitis Media with Effusion

“…Serum concentrations of Igs in patients with recurrent otitis media were lower than in a general control group or in patients with non-recurrent otitis media, with some of these differences being significant (14,28). We did not correct concentrations according to age and gender, but our results could not confirm findings showing that Ig concentrations in serum and exudates had clinical significance in patients with recurrent otitis media (29).…”

“…In addition, several studies have shown that children with low serum immunoglobulin (Ig) A, IgG, and IgM concentrations during the initial stages of otitis media have a higher incidence of recurrent OME than those with lower serum Ig concentrations (14,15). Little is known, however, regarding the association between recurrence and the concentrations of immunoglobulin in the middle ear cavity.…”