Immunological evaluation of allergic respiratory children with recurrent sinusitis

Abstract

The objective of this study was to evaluate humoral immunity of allergic respiratory children with chronic/recurrent sinusitis. Twenty-seven allergic respiratory (persistent mild/moderate asthma and persistent allergic rhinitis) children (7-15-year old) with chronic or recurrent sinusitis were evaluated. Patients had symptoms and abnormal computer tomography scan even after two adequate treatments (long-lasting antibiotics, decongestants, and short-term oral corticosteroids). clinical examination, sweat test, total blood cell count, measurement of serum levels of: total and specific IgE, immunoglobulins (G, M, A), IgG subclasses, antibodies to Haemophilus influenza type b (IgG anti-Ps Hib) and pneumococcal serotypes (IgG anti-Ps 1, 3, 5, 6B, 9V, and 14) before and after active immunization (Act-Hib and Pneumo23, Aventis Pasteur SA, Lyon, France), Rubella neutralizing antibody titers and human immunodeficiency virus antibodies. Specific IgE to inhalant allergens higher than class III were observed in 24/27 patients. One patient had IgA plus IgG2 deficiency and other an IgG3 deficiency. Eight and 12 of 27 patients had IgG2 and IgG3 serum levels below 2.5th percentile, respectively. Immunological responses to protein and polysaccharide antigens were normal in all patients. Although our patients have been appropriately treated of their allergic diseases, they persisted with chronic/recurrent sinusitis and 60% of them had a documented osteomeatal complex blockade. In spite of the diagnosis of IgA plus IgG2 deficiency and an isolated IgG3 deficiency, in all patients an adequate response to Ps antigens was observed. Primary and/or secondary humoral immunodeficiency seems not to be the main cause of chronic/recurrent sinusitis in patients with respiratory allergic disease.

Antibody response to pneumococcal capsular polysaccharide vaccine in Down syndrome patients

“…Two DS children, aged 8 and 10 years, had serum IgG2 levels below the 3rd percentile but showed an adequate increase of pneumococcal antibodies after immunization. Subnormal serum IgG2 levels do not necessarily reflect a functional immunodeficiency (21,22). An adequate response to pneumococcal antigens depends on an interaction between innate and adaptive immune responses.…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Abnormalities commonly seen include IgG subclass deficiencies, IgA deficiency, and poor response/deficiencies in pneumococcal titers. 592,1419,1420 Management with IVIG for those children resulted in decrease in antibiotic intake and reduced episodes of CRS. Children with CRS may benefit from an Ig evaluation and also titers for tetanus, diphtheria, and Pneumococcus.…”

Indications for Referral for Pediatric Rhinosinusitis

“…Humoral immunity matures to an adult level by approximately age 7 years, and children with a history of frequent bacterial infections or persistent sinus symptoms despite treatment should be referred for a thorough evaluation. Many studies have evaluated the humoral response in these patients and often show a decrease in specific immunoglobulin levels [35,36]. The most common immune deficiencies in the pediatric population are common variable, immunoglobulin G subclass, and selective antibody deficiency.…”

“…Immune deficiencies are present on 0.5 % of the pediatric population with pCRS [35,36]. Humoral immunity matures to an adult level by approximately age 7 years, and children with a history of frequent bacterial infections or persistent sinus symptoms despite treatment should be referred for a thorough evaluation.…”