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. 2017 Jul-Aug;5(4):1105-1111.
doi: 10.1016/j.jaip.2016.11.033. Epub 2017 Jan 26.

The Clinical Significance of Specific Antibody Deficiency (SAD) Severity in Chronic Rhinosinusitis (CRS)

Anjeni Keswani  1 , Neha M Dunn  2 , Angelica Manzur  2 , Sara Kashani  2 , Xavier Bossuyt  3 , Leslie C Grammer  2 , David B Conley  4 , Bruce K Tan  4 , Robert C Kern  4 , Robert P Schleimer  5 , Anju T Peters  2
Affiliations

The Clinical Significance of Specific Antibody Deficiency (SAD) Severity in Chronic Rhinosinusitis (CRS)

Anjeni Keswani et al. J Allergy Clin Immunol Pract. 2017 Jul-Aug.

Abstract

Background: Despite the increased identification of specific antibody deficiency (SAD) in chronic rhinosinusitis (CRS), little is known about the relationship between SAD severity and the severity and comorbidities of CRS. The prevalence of an impaired antibody response in the general population is also unknown.

Objective: The objective of this study was to determine if the SAD severity stratification applies to real-life data of patients with CRS.

Methods: An electronic health record database was used to identify patients with CRS evaluated for humoral immunodeficiency with quantitative immunoglobulins and Streptococcus pneumoniae antibody titers before and after pneumococcal vaccine. SAD severity was defined, according to the guidelines, based on the numbers of titers ≥1.3 μg/dL after vaccination: severe (≤2 serotypes), moderate (3-6 serotypes), and mild (7-10 serotypes). Comorbidities and therapeutic response were assessed. The prevalence of an impaired antibody response in a normal population was assessed.

Results: Twenty-four percent of the patients with CRS evaluated for immunodeficiency had SAD, whereas 11% of a normal population had an impaired immune response to polysaccharide vaccination (P < .05). When evaluated by the practice parameter definition, 239 of 595 (40%) met the definition of SAD. Twenty-four (10%) had severe SAD, 120 (50%) had moderate SAD, and 95 (40%) had mild SAD. Patients with moderate-to-severe SAD had worse asthma, a greater likelihood of pneumonia, and more antibiotic courses in the 2 years after vaccination than patients with mild SAD.

Conclusions: This study provides real world data supporting stratification of SAD by severity, demonstrating a significant increase in the comorbid severity of asthma and infections in CRS patients with moderate-to-severe SAD compared with those with mild SAD and those without SAD.

Keywords: Chronic rhinosinusitis; Immune deficiency; Specific antibody deficiency.

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Figures

Figure 1
Figure 1
Figure 1A: Prevalence of immune deficiency in chronic rhinosinusitis (n=595, using a 50% cutoff for protective antibody titers in SAD). CVID, Common variable immune deficiency; SAD, specific antibody deficiency. The normal group contains patients with a normal baseline and responders to vaccination with adequate titers post-Pneumovax®. Figure 1B: Prevalence of SAD severity phenotypes in CRS according to the Working Group classification (n=239, using a 70% cut-off for protective antibody titers). CRS, chronic rhinosinusitis; SAD, specific antibody deficiency.
Figure 1
Figure 1
Figure 1A: Prevalence of immune deficiency in chronic rhinosinusitis (n=595, using a 50% cutoff for protective antibody titers in SAD). CVID, Common variable immune deficiency; SAD, specific antibody deficiency. The normal group contains patients with a normal baseline and responders to vaccination with adequate titers post-Pneumovax®. Figure 1B: Prevalence of SAD severity phenotypes in CRS according to the Working Group classification (n=239, using a 70% cut-off for protective antibody titers). CRS, chronic rhinosinusitis; SAD, specific antibody deficiency.
Figure 2
Figure 2
Comparison of percentage of patients with impaired antibody response in normal controls vs. CRS patients evaluated for immunodeficiency. CRS, chronic rhinosinusitis.
Figure 3
Figure 3
History of pneumonia reported in the medical record as stratified by SAD severity. SAD, specific antibody deficiency
Figure 4
Figure 4
Antibiotic use in the 2 years post-Pneumovax® vaccination as classified by SAD severity. SAD, specific antibody deficiency.
See this image and copyright information in PMC

References

    1. Hamilos DL. Chronic rhinosinusitis: Epidemiology and medical management. J Allergy Clin Immunol. 2011 Oct;128(4):693–707. - PubMed
    1. Settipane GA. Epidemiology of nasal polyps. Allergy Asthma Proc. 1996 Sep-Oct;17(5):231–6. - PubMed
    1. Schwitzguebel AJ, Jandus P, Lacroix JS, Seeback JD, Harr T. Immunoglobulin deficiency in patients with chronic rhinosinusitis: Systematic review of the literature and meta-analysis. J Allergy Clin Immunol. 2015 Dec;136(6):1523–31. - PubMed
    1. Orange JS, Ballow M, Stiehm ER, Ballas ZK, Chinen J, De La Morena M, et al. 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. J Allergy Clin Immunol. 2012 Sep;130(3 Suppl):S1–24. - PubMed
    1. Bonilla FA, Khan DA, Ballas ZK, Chinen J, Frank MM, Hsu JT, et al. Practice Parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015 Nov;136(5):1186–205. e1–78. - PubMed

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