Successful intravenous immunoglobulin therapy for recurrent pneumococcal otitis media in young children

Abstract

Serum immunoglobulin levels and naturally occurring antibody titres against Streptococcus pneumoniae were measured in seven children aged 1-1.9 years with recurrent pneumococcal acute otitis media (AOM). Three of them had low IgG2 levels. Mean antibody levels of anti-pneumococcal IgG1 and anti-pneumococcal IgG2 were significantly lower in patients when compared to those of healthy controls and children who had less frequent episodes of AOM. Following treatment with intravenous immunoglobulin (IVIG) for 6 months, anti-pneumococcal IgG1 and IgG2 antibody levels increased and the number of episodes of AOM decreased in all patients. Following the discontinuation of IVIG therapy, no AOM episode occurred. Serum levels of anti-pneumococcal IgG1 and IgG2 were normal, which were measured in three subjects at 5, 6, and 12 months after the cessation of IVIG therapy. These results suggested that delayed maturation of anti-pneumococcal antibody production caused recurrent AOM and this condition was corrected by IVIG therapy.

Antipolysaccharide antibodies in 450 children with otitis media

“…1%) of children in the 2-6 year group, 32/183 (17 . 5%) in the 7-10 year group and 4/67 (6%) in the [11][12][13][14][15][16] year group had antibody levels < 0 . 15 mg/ml.…”

“…Indeed, Buckley found five cases of agammaglobulinaemia and 10 cases of hypogammaglobulinaemia in her study group. Subsequent studies from the UK, Sweden, USA and Japan performed largely on small numbers of very young children aged 6-36 months with recurrent otitis media as their main clinical problem have produced conflicting results, ranging from low serum IgG2 subclass levels, accompanied by reduced spontaneous antibody levels, to S. pneumoniae type 6 to increased serum IgG2 levels [10][11][12][13][14][15][16]. These studies are difficult to interpret in view of the physiological delay in achieving normal IgG2 subclass levels in this age group (6-32 months) and the accompanying failure to mount an adequate polysaccharide antibody response [18].…”

Effects of Japanese herbal medicine, Juzen-taiho-to, in otitis-prone children – a preliminary study

“…It is thought that the immaturity of immune function, such as lower serum IgG2 levels [13,14] and low concentration of serum anti-P6 IgG [15], is the main reason that a majority of otitis-prone patients are under 3 years of age, and it is also reported that response and development of immune function are poor in otitis-prone children [14,15]. Despite the standard treatment for AOM including oral administration of antibiotics and tympanostomy, some patients are unable to recover from intractable infection, and require hospitalization for intravenous administration of antibiotics or immunoglobulin [17]. Intractable inflammation of the middle ear also occasionally leads to serious conditions, such as mastoiditis, meningitis, cerebritis, subperiosteal abscess of mastoid process, and sigmoid sinus thrombophlebitis.…”

Successful discontinuation of immunoglobulin G replacement at age 10 in a patient with immunoglobulin G2 deficiency

“…She received inhaled steroid and beta-stimulants, and oral or intravenous theophylline, but was not intubated nor intensive care unit (ICU)-managed. She stayed for several days to 3 weeks for each admission from 6 months of age until 3 years and 11 months of age, when she was diagnosed with IgG2 deficiency and specific polysaccharide antibody deficiency, due to low serum IgG2 (57.4 mg/dL, with 58.5–292.1 mg/dL representing ±1.96 standard deviation (SD) range for healthy Japanese children 2–4 years old 7 ) and low anti-pneumococcal (PC) IgG2 (0.7 µg/mL, with 4.3 µg/mL representing an average level for healthy children 1–2 years old 8 ). Other IgG subclasses and IgG, IgA, and IgM, were within normal range (IgG1, 475.4 mg/dL; IgG3, 27.7 mg/dL; IgG4, 1.2 mg/dL; IgG, 526–562 mg/dL; IgA, 36 mg/dL; and IgM, 121 mg/dL).…”