Lack of Clinical Hypersensitivity to Penicillin Antibiotics in Common Variable Immunodeficiency

Hartman, Heather; Schneider, Karrie; Hintermeyer, Mary; Bausch-Jurken, Mary T.; Fuleihan, Ramsay; Sullivan, Kathleen E.; Cunningham‐Rundles, Charlotte; Bonilla, Francisco A.; Verbsky, James; Routes, John M.

doi:10.1007/s10875-016-0353-7

Cited by 10 publications

(6 citation statements)

References 5 publications

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“…We were unable to detect specific allergen sensitization in 96.5% of patients, with only low titer IgE detected in 3 patients. This is consistent with a general inability to detect allergen sensitization via serum and/or skin prick testing in patients with CVID, despite many patients reporting symptoms of rhinitis, wheeze, or adverse reactions to antibiotics [14, 13, 30, 16]. We hypothesize that most patients with CVID are unable to generate new antigen-specific IgE and thus are not at risk for the development of new allergic disease.…”

Section: Discussionsupporting

confidence: 78%

“…This has been based on IgE concentrations in non-immunodeficient subjects being highly variable, due to the presence of atopic disease such as allergic rhinitis, asthma, food allergy and atopic dermatitis as well as other conditions including parasitic disease. However, prior studies of patients with CVID have demonstrated that the majority have a low serum IgE [9–16]. It is important to note that these previous studies were performed on small cohorts and nearly one third of the data were generated prior to the introduction of the ImmunoCAP solid phase sandwich immunoassay in 1989, which has greater sensitivity and validity than previously utilized tests.…”

Section: Introductionmentioning

confidence: 99%

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Low Serum IgE Is a Sensitive and Specific Marker for Common Variable Immunodeficiency (CVID)

et al. 2018

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Although small prior studies have suggested that IgE can be low in common variable immunodeficiency (CVID), the workup for patients with recurrent infections and suspected hypogammaglobulinemia does not include the routine measurement of serum IgE. We sought to test the hypothesis that low/undetectable serum IgE is characteristic of CVID by comparing the frequency of low/undetectable serum IgE in healthy controls and patients with CVID. We measured total serum IgE in a large multi-center cohort of patients with CVID (n = 354) and compared this to large population-based cohorts of children and adults. We further compared IgE levels in patients with CVID to those with other forms of humoral immunodeficiency, and in a subset, measured levels of allergen-specific serum IgE and IgG subclasses. Lastly, we evaluated for the presence of IgE in commercially available immunoglobulin replacement therapy (IgRT) products. An undetectable serum IgE (< 2 IU/ml) occurs in only 3.3% (95% CI, 1.9-5.7%) of the general population. In contrast, an undetectable IgE occurs in 75.6% (95% CI, 65.6-85.7%) of patients with CVID. Conversely, a high IgE (> 180 IU/ml) is very uncommon in CVID (0.3% of patients). IgE is > 2 IU/ml in 91.2% of patients with secondary hypogammaglobulinemia, and thus, an IgE < LLOD is suggestive of a primary humoral immunodeficiency. Allergen-specific IgE is not detectable in 96.5% of patients with CVID. Sufficient quantities of IgE to change the total serum IgE are not contained in IgRT. The IgG1/IgG4 ratio is increased in subjects with low IgE, regardless of whether they are controls or have CVID. These findings support the routine measurement of serum IgE in the workup of patients with hypogammaglobulinemia.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Low Serum IgE Is a Sensitive and Specific Marker for Common Variable Immunodeficiency (CVID)

et al. 2018

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“…A limited number of studies in literature have evaluated DHR in CVID patients. In those studies, the frequency of immediate type DHR has been reported to vary between 7% and 13% 22, 29, 30. Similarly, in the current study, immediate type DHR was determined at a frequency of 6%, and the most common complaint on presentation was urticaria, again similar to previous studies 29.…”

Section: Discussionmentioning

confidence: 95%

Allergic Diseases as a Clinical Phenotype Marker in Patients with Common Variable <bold>Immunodeficiency</bold>

Yıldız¹,

Çölkesen²,

Arslan³

et al. 2023

Int Arch Allergy Immunol

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Introduction: Patients with common variable immunodeficiency (CVID) have been shown to be more predisposed to develop allergic diseases because of mucosal immune defects and immune dysregulation. The aim of this study was to determine the prevalence, and clinical and laboratory characteristics of various allergic diseases in patients with CVID. Methods: The study included patients aged ≥18 years who were followed up for a diagnosis of CVID. Patients were separated into 5 groups according to the clinical phenotypic characteristics of lymphoproliferation, autoimmunity, gastrointestinal diseases, allergic diseases, and malignancy. Atopic dermatitis (AD), drug hypersensitivity reaction (DHR), allergic rhinitis (AR), and asthma were accepted as allergic diseases. Results: The most commonly seen clinical phenotypes were lymphoproliferation in 41 (48.8%) patients and allergic diseases in 31 (37%). AD was determined in 2 (2.4%) patient, DHR in 5 (6%), AR in 7 (8.3%), and asthma in 21 (25%). The delay in diagnosis of patients with allergic disease was determined to be shorter compared to those without allergic disease (p = 0.042). Serum total immunoglobulin E level, CD19+ B cell, switched memory B cell, and natural killer cell counts were determined to be higher in the CVID patients with allergic disease compared to those without (p = 0.007, p = 0.022, p = 0.023, p = 0.017, respectively). Conclusion: Allergic diseases should be considered as a marker of clinical phenotype in CVID because of the clinical and immunological differences. Early diagnosis and treatment of allergic diseases in patients with CVID can improve quality of life.

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“…All these immune mechanisms are variably deficient in patients with IEI, so they may be partially protected against this kind of immune-mediated reactions. This could be hypothesized also for anaphylaxis: PID patients often exhibit absent to low IgE levels and lack many immunological mechanisms that mediate immediate allergic reactions [41].…”

Section: Discussionmentioning

confidence: 99%

Safety of mRNA COVID-19 Vaccines in Patients with Inborn Errors of Immunity: an Italian Multicentric Study

et al. 2022

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Purpose Little is known about vaccine safety in inborn errors of immunity (IEI) patients during the current vaccination campaign for COVID-19. To better investigate the reactogenicity and adverse event profile after two, three, and four doses of mRNA vaccines, we conducted an observational, multicentric study on 342 PID patients from four Italian Referral Centres. Methods We conducted a survey on self-reported adverse reactions in IEI patients who received mRNA vaccine by administering a questionnaire after each dose. Results Over the whole study period, none of the patients needed hospitalization or had hypersensitivity reactions, including anaphylaxis and delayed injection site reaction. After two vaccination doses, 35.4% of patients showed only local reactogenicity-related symptoms (RrS), 44.4% reported both systemic and local RrS, and 5% reported only systemic RrS. In more than 60% of cases, local or systemic RrS were mild. After the first and second booster doses, patients showed fewer adverse events (AEs) than after the first vaccination course. Patients aged 50 years and older reported adverse events and RrS less frequently. Among AEs requiring treatment, one common variable immune deficiency patient affected by T cell large granular lymphocytic leukemia developed neutropenia and one patient had Bell’s paralysis perhaps during herpes zoster reactivation. Conclusion Although our follow-up period is relatively short, the safety data we reported are reassuring. This data would help to contrast the vaccine hesitancy often manifested by patients with IEI and to better inform their healthcare providers.

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Lack of Clinical Hypersensitivity to Penicillin Antibiotics in Common Variable Immunodeficiency

Cited by 10 publications

References 5 publications

Low Serum IgE Is a Sensitive and Specific Marker for Common Variable Immunodeficiency (CVID)

Low Serum IgE Is a Sensitive and Specific Marker for Common Variable Immunodeficiency (CVID)

Allergic Diseases as a Clinical Phenotype Marker in Patients with Common Variable <bold>Immunodeficiency</bold>

Safety of mRNA COVID-19 Vaccines in Patients with Inborn Errors of Immunity: an Italian Multicentric Study

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