Low Baseline Pneumococcal Antibody Titers Predict Specific Antibody Deficiency, Increased Upper Respiratory Infections, and Allergy Sensitization

Abstract

Background: Inadequate titers of pneumococcal antibody (PA) are commonly present among patients with recurrent respiratory infections. Objective: We sought to determine the effect of the degree of inadequacy in baseline PA titers on the subsequent polysaccharide vaccine response, the incidence of sinusitis, and allergic conditions. Methods: A total of 313 patients aged 6 to 70 years with symptoms of recurrent respiratory infections were classified by baseline-pPA (percentage of protective [1.3 mg/mL] PA serotypes/total tested serotypes) and postvaccination pPA (post-pPA): Group A (adequate baseline-pPA), Group B (inadequate baseline-pPA, adequate post-pPA, responders), and Group C (inadequate baseline-pPA, inadequate postpPA, nonresponders, specific antibody deficiency [SAD]). Immunity against Streptococcus pneumoniae was defined as adequate when the pPA was 70%. Each group and combined groups, Group AB (inadequate baseline-pPA), and Group BC (adequate post-pPA) were analyzed for demographics, history of sinusitis, recurrent sinusitis in the following year, allergic conditions, and association with inadequate individual serotype titers. Results: Over 80% of patients with respiratory symptoms had inadequate baseline-pPA. Baseline-pPA and SAD prevalence are inversely related (odds ratio ¼ 2.02, 95% CI: 1.15-3.57, P ¼.01). Inadequate serotype 3 antibody titer is highly associated with SAD (odds ratio ¼ 2.02, 96% CI: 1.61-5.45, P <.01). The groups with inadequate pPA (Group B and C, or BC) had significantly higher percentage of patients with chronic rhinosinusitis (P <.001), allergic sensitization, and allergic rhinitis (P <.05). Group A contained higher percentage of patients with recurrent upper airway infections (P <.001). Conclusion: Low baseline-pPA and low antibody titers to serotype 3 are highly associated with SAD, increased incidence of respiratory infections including CRS and allergic conditions.

Screening Identifies Suboptimal Vaccination Protection in Illness-Susceptible Elite Athletes

“…14 Although defining "protective" thresholds is problematic, as this can differ depending on a range of factors such as age, individual pneumococcal serotype, and assay methodology, individuals with chronic lung disease such as asthma with low baseline pneumococcal antibody levels have been shown to have an increased prevalence of respiratory infections. 15 Our study shows a wide range of pneumococcal antibody concentrations in elite athletes, but that approximately a quarter of the athlete cohort with a history of RTI susceptibility or asthma should consider vaccination based on their pneumococcal antibody responses. Given individuals with low baseline pneumococcal antibodies have an increased risk of RTI and a possible underlying partial antibody deficiency and vaccination can potentially lead to improved short-term clinical outcomes, 15 we suggest a pragmatic approach to assess the risk benefit of routine pneumococcal immunization in elite athletes with RTI susceptibility.…”

“…15 Our study shows a wide range of pneumococcal antibody concentrations in elite athletes, but that approximately a quarter of the athlete cohort with a history of RTI susceptibility or asthma should consider vaccination based on their pneumococcal antibody responses. Given individuals with low baseline pneumococcal antibodies have an increased risk of RTI and a possible underlying partial antibody deficiency and vaccination can potentially lead to improved short-term clinical outcomes, 15 we suggest a pragmatic approach to assess the risk benefit of routine pneumococcal immunization in elite athletes with RTI susceptibility.…”

Evaluation and treatment of rhinosinusitis with primary antibody deficiency in adults: Evidence‐based review with recommendations

“…This yielded a total of 42 papers included in the systematic review (Figure 1). 8–49 The Oxford levels of evidence assigned included eight level 3 studies, and 34 level 4 studies, encompassing case series/retrospective reviews, case–control, and prospective studies. Additionally, four systematic reviews related to this topic were identified 4,5,50,51 .…”

“…More than half of the reviewed studies aimed to determine the prevalence of PAD in patients with rhinosinusitis or to determine the prevalence of rhinosinusitis in patients with PAD. [8][9][10][12][13][14]17,19,22,27,31,37,38,[41][42][43]48,52 There was a great deal of variability in the definition of chronic and recurrent rhinosinusitis population among the studies.…”

Health‐care utilization for sinusitis after pneumococcal vaccination in patients with low antibody titers

“…The presence of sufficient antibody titers to S pneumoniae may represent an adequate humoral immune response that would feasibly be effective against similar pathogens with polysaccharide antigens such as Moraxella catarrhalis and Haemophilus influenzae. 13,14 Given the apparent benefit of immunization, redefining adequate titers as 70% of serotypes ≥1.3 µg/mL instead of the current standard of 50% may decrease incidence of sinusitis through vaccination of those with borderline titers. 15 Future study may reveal that younger patients who have received PCV7 or PCV13 with childhood vaccination have increased pneumococcal protection and less associated disease burden.…”