Use of vaccines in the evaluation of presumed immunodeficiency

Abstract

The assessment of the humoral immune response is a critical component in the evaluation of patients suspected of having a primary immune deficiency disease (PIDD). [1] Bonilla F.A. Bernstein I.L. Khan D.A. Chinen J. Frank M. Kobrynski L. Practice parameter for the diagnosis and management of primary immunodeficiency. Ann Allergy Asthma Immunol. 2005; 94: S1-S63 Abstract Full Text PDF PubMed Scopus (437) Google Scholar In fact, more than 50% of the patients with immune deficiency have some impairment in the ability to make specific antibodies and/or have a quantitative deficiency of antibodies. Although there are a number of laboratory tools that are helpful in the evaluation of patients suspected of having an antibody deficiency disorder, such as quantitative serum immunoglobulin analysis, analysis of lymphocyte subpopulations by flow cytometry, or even genetic diagnoses of single-gene mutations, the evaluation of a patient's response to immunization with a vaccine and the production of specific antibodies are extremely important. The assessment of qualitative antibody responses is not only important in confirming a specific antibody immune deficiency but is also important in the decision-making process for using immunoglobulin replacement therapy. 2 Stiehm E. The four most common peditric immunodefiencies. J Immunotoxicol. 2008; 5: 227-234 Crossref PubMed Scopus (59) Google Scholar , 3 Stiehm E. Orange J. Ballow M. Lehman H. Therapeutic use of immunoglobulins. Adv Pediatr. 2010; 57: 185-218 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar If on initial evaluation patients demonstrate a deficient quantitative antibody response, an antigen challenge or booster vaccine immunization with existing Food and Drug Administration (FDA)–approved vaccines can determine whether the patient has the ability to generate an adequate qualitative antibody response. In an effort to provide guidance in the evaluation of patients for a humoral PIDD, a working group of the Basic and Clinical Immunology Interest Section of the American Academy of Allergy, Asthma and Immunology (AAAAI) published a report in September 2012. [4] Orange J. Ballow M. Stiehm E. Ballas Z. Chinen J. De La Morena M. Use and interpretation of diagnostic vaccination in primary immunodeficiency: a working group report of the Basic and Clinical Immunology Interest Section of the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol. 2012; 130: S1-S24 Abstract Full Text Full Text PDF PubMed Scopus (289) Google Scholar This article discusses some of the topics related to the use and interpretation of vaccine responses in the evaluation of patients for a possible PIDD.