Journal of Allergy and Clinical Immunology
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 & Immunology
Section snippets
Use of common vaccines for measurement of humoral immune function
Summary Statement 1: The most commonly used vaccines for B-cell functional analysis are US Food and Drug Administration (FDA) approved and used worldwide in children to prevent communicable diseases. (Ia A)
Summary Statement 2: The diagnosis and treatment of common variable immunodeficiency (CVID) has traditionally included assessment of vaccine responses. (IIa B)
Summary Statement 3: There are 4 primary immunodeficiencies that largely depend on qualitative analysis of vaccination responses. (IV
Use of common vaccines for measurement of humoral immune function
A substantial number of vaccines are licensed for prophylactic use in the United States (Table I), and many are part of required or recommended vaccination series. Multiple PIDD diagnoses depend in part on the evaluation of the responses to these routine antigenic exposures. For direct guidance regarding the diagnosis of specific PIDDs, the reader is referred to the current (and any future) Joint Council of Allergy, Asthma & Immunology Practice Parameter on PIDDs.4 The following summary
Use of alternative vaccines and true neoantigens in evaluating defective humoral immunity
Summary Statement 46: Immunization with neoantigens can be used in the evaluation of specific antibody response in the setting of immunoglobulin replacement therapy. (III C)
The AAAAI’s “Practice parameter for the diagnosis and management of primary immune deficiency”4 recommends the use of standard childhood immunization for assessing antibody responses. Immunization with the neoantigen bacteriophage φX174 is an option in some centers for the evaluation of patients who are receiving
Variability in immunogenicity among currently available vaccines
Although rare, variability among vaccine lots does occur and can result in decreased immunogenicity and even vaccine failure. Conceivably, this could lead to inappropriate conclusions when vaccines are used in the assessment of immune competence. Ongoing efforts to standardize specifications for raw materials, production facilities, manufacturing processes, and control testing of vaccines are robust and imperative. General aspects pertaining to potential variability, as well as issues specific
Conclusion
The use of vaccine responses as a diagnostic tool is firmly established for the evaluation of patients undergoing immunologic evaluation. They are frequently used in the context of providing a diagnosis or for justifying a particular therapeutic intervention. However, it is important to recognize that a knowledge gap exists regarding the issue of the different titer responses associated with the specific sequence of vaccination formulations (eg, PCV before PPV or vice versa). The effect
References (167)
- et al.
Genetic diagnosis of primary immune deficiencies
Immunol Allergy Clin North Am
(2008) - et al.
Primary immunodeficiencies: 2009 update
J Allergy Clin Immunol
(2009) - et al.
The EUROclass trial: defining subgroups in common variable immunodeficiency
Blood
(2008) - et al.
Differences in the immunogenicity of three Haemophilus influenzae type b conjugate vaccines in infants
J Pediatr
(1992) - et al.
Immunogenicity and reactogenicity of a group C meningococcal conjugate vaccine compared with a group A+C meningococcal polysaccharide vaccine in adolescents in a randomised observer-blind controlled trial
Vaccine
(2000) - et al.
Immunogenicity, safety and lot consistency in adults of a chromatographically purified Vero-cell rabies vaccine: a randomized, double-blind trial with human diploid cell rabies vaccine
Vaccine
(2001) Persistence of antitoxin in man following active immunisation
Lancet
(1943)- et al.
Active vaccination in patients with common variable immunodeficiency (CVID)
Clinical Immunol
(2007) - et al.
Serum bactericidal antibody response to serogroup C polysaccharide meningococcal vaccination in children with primary antibody deficiencies
Vaccine
(2007) - et al.
Memory B cells in common variable immunodeficiency: clinical associations and sex differences
Clin Immunol
(2008)
Assessment and clinical interpretation of reduced IgG values
Ann Allergy Asthma Immunol
Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology
J Allergy Clin Immunol
Therapy for patients with recurrent infections and low serum IgG3 levels
J Allergy Clin Immunol
Selective IgG1 deficiency
Clin Immunol Immunopathol
The outcome of patients with hypogammaglobulinemia in infancy and early childhood
J Pediatr
Impaired specific antibody response and increased B-cell population in transient hypogammaglobulinemia of infancy
Ann Allergy Asthma Immunol
The Wiskott-Aldrich syndrome: studies of lymphocytes, granulocytes, and platelets
Blood
A multiinstitutional survey of the Wiskott-Aldrich syndrome
J Pediatr
Transient hypogammaglobulinemia of infancy: review of the literature, clinical and immunologic features of 11 new cases, and long-term follow-up
J Pediatr
Age- and serotype-dependent antibody response to pneumococcal polysaccharides
J Allergy Clin Immunol
Pneumococcal vaccine prevents death from acute lower-respiratory-tract infections in Papua New Guinean children
Lancet
Adenosine deaminase deficiency in adults
Blood
A mutation in Bruton’s tyrosine kinase as a cause of selective anti-polysaccharide antibody deficiency
J Pediatr
Anti-pneumococcal antibody response in normal subjects: a meta-analysis
J Allergy Clin Immunol
Antibody response to pneumococcal vaccination as a function of preimmunization titer
J Allergy Clin Immunol
Severe combined immunodeficiency (SCID) and rotavirus vaccination: reports to the Vaccine Adverse Events Reporting System (VAERS)
Vaccine
Disseminated Bacille Calmette-Guerin in Iranian children with severe combined immunodeficiency
Int J Infect Dis
Assessment and clinical interpretation of polysaccharide antibody responses
Ann Allergy Asthma Immunol
Pneumococcal vaccine and otitis media
Lancet
Validation of current joint American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma and Immunology guidelines for antibody response to the 23-valent pneumococcal vaccine using a population of HIV-infected children
J Allergy Clin Immunol
Influence of age on the response to Streptococcus pneumoniae vaccine in patients with recurrent infections and normal immunoglobulin concentrations
J Allergy Clin Immunol
Preimmunization and postimmunization pneumococcal antibody titers in children with recurrent infections
Ann Allergy Asthma Immunol
Total and serotype specific pneumococcal antibody titres in children with normal and abnormal humoral immunity
Vaccine
Serological criteria for evaluation and licensure of new pneumococcal conjugate vaccine formulations for use in infants
Vaccine
Correlates of immunity for pneumococcal conjugate vaccines
Vaccine
Combined schedules of pneumococcal conjugate and polysaccharide vaccines: is hyporesponsiveness an issue?
Lancet Infect Dis
A comparison of multiple regimens of pneumococcal polysaccharide-meningococcal outer membrane protein complex conjugate vaccine and pneumococcal polysaccharide vaccine in toddlers
Vaccine
Defective anti-pneumococcal polysaccharide antibody response in children with recurrent respiratory tract infections
J Allergy Clin Immunol
Comparison of antibody kinetics following meningococcal serogroup C conjugate vaccine between healthy adults previously vaccinated with meningococcal A/C polysaccharide vaccine and vaccine-naive controls
Vaccine
Practice parameter for the diagnosis and management of primary immunodeficiency
Ann Allergy Asthma Immunol
Duration of antibody response after meningococcal polysaccharide vaccination in US Air Force personnel
J Infect Dis
Haemophilus influenzae type b conjugate vaccines
Immunology
The protective level of serum antibodies to the capsular polysaccharide of Haemophilus influenzae type b
J Infect Dis
Meningococcal vaccine development: a novel approach
Expert Opin Investig Drugs
Clinical efficacy of meningococcus group A capsular polysaccharide vaccine in children three months to five years of age
N Engl J Med
B- and T-cell immune responses to pneumococcal conjugate vaccines: divergence between carrier- and polysaccharide-specific immunogenicity
Infect Immun
Rabies antibody levels in bat handlers in the United Kingdom: immune response before and after purified chick embryo cell rabies booster vaccination
Human vaccines
A population-based serologic survey of immunity to tetanus in the United States
N Engl J Med
Characterization of specific immunoglobulin G (IgG) and its subclasses (IgG1 and IgG2) against the 23-valent pneumococcal vaccine in a healthy adult population: proposal for response criteria
Clin Diagn Lab Immunol
The four most common pediatric immunodeficiencies
J Immunotoxicol
Cited by (0)
Publication of this article was supported by CSL Behring.
Disclosure of potential conflict of interest: J. S. Orange has received consultancy fees from Baxter Bioscience, Grifols, Octapharma USA, CSL Behring, IBT Reference Laboratories, and Cangene; has received lecture fees from Baxter Bioscience; and receives royalties from UpToDate. M. Ballow has received consulting fees from Baxter, CSL Behring, Grifols; has received fees for participation in review activities from Green Cross DSMB; has received legal fees to review a case; has received lecture fees from Baxter, CSL Behring, and the ACAAI; and has received payment for manuscript preparation from Baxter. E. R. Stiehm has received consultancy fees from UpToDate; is employed by Vela; has provided expert witness testimony on the topic of vaccine adverse effects; has received an unrestricted donation to Dr. Roger Kobayashi Allergy and Immunology Associates of Omaha for travel expenses; and has received travel expenses from the US Immune Deficiency Foundation and March of Dimes. Z. K. Ballas has received research support from Talecris, VA, and the National Institutes of Health (NIH); receives royalties from UpToDate; and has served as a member of the AAAAI Board of Directors. M. De La Morena has received research support from the Jeffrey Modell Foundation. D. Kumararatne has received research support from NIHR, UK; has received consultancy fees from Viropharma; has received lecture payments from Baxter; and has received travel funds from CSL Behring. S. McGhee has received lecture fees from Baxter. E. E. Perez has received consultancy fees from Baxter and CSL Behring; is employed by the University of South Florida; and has received payment for the development of educational presentations from Baxter. J. Raasch has received lecture fees from Baxter and CSL Behring and has received payment for the development of educational presentations from Baxter. H. Schroeder has received research support from the NIAID, NABI Pharmaceuticals, and Green Cross Pharmaceuticals; has received lecture fees from the AAAAI and NABI Pharmaceuticals; and has received royalties from Elsevier as the editor of Clinical Immunology: Principles and Practices. C. Seroogy has received consultancy fees from UpToDate; is employed by the University of Wisconsin; and has received research support from Midwest Athletes Against Childhood Cancer and the NIH. A. Huissoon has served on the Advisory Boards for Biotest, Shire, Swedish Orphan Biovitrum, and Meda; has received lecture fees from GlaxoSmithKline; holds shares in GlaxoSmithKline; has received travel expenses from CSL Behring; and has organized meetings that have been funded by The Binding Site, Ltd. The rest of the authors have declared that they have no relevant conflicts of interest.