Abstract
BackgroundWe sought to compare Pneumovax®23 responses in adults with subnormal IgG subclass concentrations. We studied adults with normal total IgG, frequent/severe respiratory infection, and subnormal IgG1, IgG3, or IgG1 + IgG3 before and after Pneumovax®23. We defined response as serotype-specific IgG > 1.3 μg/mL and aggregate response as IgG > 1.3 μg/mL for ≥70% of all serotypes tested. We compared patients with and without serotype-specific responses and performed logistic regression on aggregate responses using: age; male sex; body mass index; autoimmune condition(s); atopy; other allergies; subnormal IgGSc immunophenotypes; IgA; and IgM.ResultsThere were 59 patients (mean age 44 ± 13 (SD) years; 83.1% women). Median days between pre- and post-Pneumovax®23 testing was 33 (range 19–158). The median post-vaccination summated concentration of serotype-specific IgG was higher in patients with subnormal IgG1 than subnormal IgG3 (responders and non-responders). All subnormal IgG1 + IgG3 non-responders responded to serotypes 8, 9 and 26, unlike other non-responders. Subnormal IgG3 responders had lower responses to serotypes 1, 4, 12, 23, 26, and 51. Subnormal IgG3 non-responders had higher responses to serotypes 1, 3, 8, 9, 12, 14, 19, 51, and 56. Response rates decreased with increasing age. Aggregate responders were: subnormal IgG1, 54%; IgG3, 46%; and IgG1 + IgG3, 46%. Regression on aggregate response revealed lower response with male sex (odds ratio 0.09 [95% CI 0.01, 0.77]) and atopy (0.17 [0.03, 0.83]).ConclusionsSerotype-specific IgG responses to Pneumovax®23 were greater in patients with subnormal IgG1 than subnormal IgG3. Male sex and atopy were associated with lower aggregate responses.
Highlights
We sought to compare Pneumovax®23 responses in adults with subnormal IgG subclass concentrations
We studied the records of unrelated non-Hispanic white adults (≥18 years of age) referred to a single practice in a large suburban medical center that evaluates and treats many adult patients with primary immunodeficiency
Three patients (5.1%) had subnormal IgM. χ2 analysis of the proportions of men in the three subnormal IgG subclass (IgGSc) groups rejected the null hypothesis (p = 0.03). This was due to the lower proportion of men with subnormal IgG3 than subnormal IgG1 + IgG3 (6.1% vs. 38.5%, respectively; p = 0.014) (Table 1)
Summary
We sought to compare Pneumovax®23 responses in adults with subnormal IgG subclass concentrations. We studied adults with normal total IgG, frequent/severe respiratory infection, and subnormal IgG1, IgG3, or IgG1 + IgG3 before and after Pneumovax®23. We compared patients with and without serotype-specific responses and performed logistic regression on aggregate responses using: age; male sex; body mass index; autoimmune condition(s); atopy; other allergies; subnormal IgGSc immunophenotypes; IgA; and IgM. Subnormal IgG subclass (IgGSc) concentrations in some adults represent a primary immunodeficiency disorder(s) characterized by frequent or severe respiratory tract infections, suboptimal IgG responses to pneumococcal polysaccharides, and increased prevalence of autoimmune disorders and atopy [1,2,3]. Some individuals with subnormal IgG1 have frequent or severe infections, especially of the respiratory tract [7, 8].
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