Immune Tests Are In - IgA ?

[Suzan]

So we got our immune tests back yesterday. Everything normal except:

 

Low normal IgA - do we know the significance of this (if any) yet and how low would rule out IVIG? I tried to search on this but could not find any standard, maybe it's just not known right now.

 

DD7's IgA is 37 with a low lab range of 34.

 

Also, she failed her streptococcus pneumanae test, 11 or 12 out of 14 are low. Trying to figure out what to do now and find a good immunologist who understands all this. I will travel if I have to but hope to somehow find someone close to home (Charlotte, NC).

 

Susan

(dd 6 is watching and wanted me to post that )

[peglem]

Generally, the streptococcus pneumonia test is run the 1st time to get a baseline read. Technically it isn't a failure because there has been no immunization- this test and the pneumovax are used to test the immune response. Once they have baseline titers, they usually administer the pneumovax and after 2-4 weeks, retest for titers to see if there was an immune response to the vaccine. When my daughter did this she showed no response to the pneumovax the 1st time. She was revaxinated and did show an adequate immune response to the 2nd vax.

[Suzan]

Generally, the streptococcus pneumonia test is run the 1st time to get a baseline read. Technically it isn't a failure because there has been no immunization- this test and the pneumovax are used to test the immune response. Once they have baseline titers, they usually administer the pneumovax and after 2-4 weeks, retest for titers to see if there was an immune response to the vaccine. When my daughter did this she showed no response to the pneumovax the 1st time. She was revaxinated and did show an adequate immune response to the 2nd vax.

 

I thought it would be a bad idea to vaccinate for strep in PANDAS kid??

[peglem]

Generally, the streptococcus pneumonia test is run the 1st time to get a baseline read. Technically it isn't a failure because there has been no immunization- this test and the pneumovax are used to test the immune response. Once they have baseline titers, they usually administer the pneumovax and after 2-4 weeks, retest for titers to see if there was an immune response to the vaccine. When my daughter did this she showed no response to the pneumovax the 1st time. She was revaxinated and did show an adequate immune response to the 2nd vax.

 

I thought it would be a bad idea to vaccinate for strep in PANDAS kid??

 

Yeah, I asked about that....was told its not the same kind of strep. I don't think there is a vaccine to strep A or B. I remember checking out the vaccine online very carefully back then before I decided it was safe enough. My daughter had chronic strep at the time to, and they would not give it when she had an infection, so I'd schedule the vax, have her checked the day before, then call and reschedule for the day after abx course would be complete. I don't think it brought on an exacerbation for her, although she did have chronic strep at the time, so I may not have known if it was strep or vax causing reaction.

[ShaesMom]

Generally, the streptococcus pneumonia test is run the 1st time to get a baseline read. Technically it isn't a failure because there has been no immunization- this test and the pneumovax are used to test the immune response.

 

 

The Prevnar vaccine was introduced in the year 2000 so many of the younger kids have been vaccinated for the streptococcus pneumonea. My dd7 received four Prevnar shots between the ages of 2-3. So, when she failed it was not considered a baseline read but a true failure and was enough for immuno doctor to dx her with Selective Antibody Deficiency and start monthly IVIG.

 

I know of two additional children who have also failed the pneumococcal titers test and been dx'd with SAD and started on IVIG without revaxing. I believe different doctors are handling this situation different. I can't begin to say who is right or wrong only that there seems to be a lot of inconsistancy in how it is handled. Our immuno doctor (whom I have nothing good to say about) is connected with UCLA and plays a big role with the Primary Immune Deficiency Foundation and has won awards. He supposedly is one of the best. His bed side manner leaves a lot to be desired.

 

I have read on the PID forum that many doctors do indeed give the Pneumovax vaccine after a failed titers response and then retest. Interestingly, many of the individuals are adults who have never been vaccinated for it.

 

I personally don't believe at this point that I would let anyone give my dd a vaccine with any form of streptococcus because while it is believed at this time that there is no connection between the different forms of strep--I don't think anyone can give us a 100% guarantee at this time. There are too many unknowns in medicine IMO.

[mom md]

Maeve O' Connor at Charlotte Allergy said she is interested in seeing us for PANDAS. We are set to see her Sept 9th. I am sure she could help you.

[Buster]

We too had low PREVNAR reaction for 11 of the 14 seratypes. Our immunologist wasn't particularly concerned with this despite our pointing out that our dd had been vaccinated 4 times. I think this is sure an interesting coincidence and worth seeing if others have had similar results.

 

Regards,

 

Buster

[Suzan]

We too had low PREVNAR reaction for 11 of the 14 seratypes. Our immunologist wasn't particularly concerned with this despite our pointing out that our dd had been vaccinated 4 times. I think this is sure an interesting coincidence and worth seeing if others have had similar results.

 

Regards,

 

Buster

 

Buster, out of curiosity, which did your dd "pass"?

 

My dd was not low on 23F and 19F and 5 was a 2.0.

 

Susan

[ShaesMom]

My dd also passed both 23F and 19F--failed all the rest. I have been in contact with another Mom that I "met" on the PID forum who has a son age 9 that has Pandas and a PID. He was dx'd with his PID because he failed the same pneumococcal titers.

 

I wasn't going to post anything regarding this until next week because we are awaiting the results of another child's pneumococcal results but so far another Mom and myself have ran across a total of six children with Pandas who have failed this blood test. So, we know six who have had the test and those same six have all failed. Very interesting outcome so far. I'll keep you posted.

 

Sam

 

We too had low PREVNAR reaction for 11 of the 14 seratypes. Our immunologist wasn't particularly concerned with this despite our pointing out that our dd had been vaccinated 4 times. I think this is sure an interesting coincidence and worth seeing if others have had similar results.

 

Regards,

 

Buster

 

Buster, out of curiosity, which did your dd "pass"?

 

My dd was not low on 23F and 19F and 5 was a 2.0.

 

Susan

[kim]

I wonder if anyone knows more about this than I do, or can get clarification from a Dr? I'm questioning how long you would expect to see elevated titers from a Prevnar? When you think about it, older adults get a P. shot annually not a series, then you're done. I know they figure immunity wanes more quickly in older adults, however with Prevnar, I think it's given at a time frame where they figure "protective anitbody" formation is possible (i.e. if given earlier immune system doesn't respond due to age) and they keep giving it until they figure the child is out of the woods so to speak, because if protective levels decline (after that 4th immunization) the child will be old enough that it's no big deal to fight off the P. The other thing, "titer' levels are not always indicative of "protection." You may see low or absent levels but the when the body encounters a particul antigen again, it "remembers" it, because it has seen it before (i think this is the theory, personally i question if any of these vaccines work nearly as well as we've been lead to believe). Relying on a vaccine where the series had been completed some years prior, seems like it could have some problems. Also, the types that are showing as positive, may have been naturally occuing that the children had from natural exposure????

This is what is making me wonder if a challenge vaccine would be necessairy as Peglems's daughter had.

 

I found one article that touches on what I'm talking about here, altho it's not that great because it's talking about a 23 valent vaccine, Prevnar is 7. It's talking about older adults etc. but i think it helps to clarify what I'm questioning.

 

I guess if my child was given a diagnosis of PID based on the results of this type of testing, I would want to know what levels are in children not suspected of immune funtion problems. Maybe someone can find a better study specific to Prevnar? I would really like to understand this whole thing!

 

 

http://74.125.95.132/search?q=cache:-5O42q...=clnk&gl=us

 

Page 6

 

Efficacy and effectiveness

 

 

also page 8

 

Durability of immune response and duration of protection

 

PPV23 induces an initial rise in antibody titres, which decline over time. In older adults, antibody titres mea-sured 4–7 years after vaccination tend to approximate pre-vaccination baseline titres. The clinical significance of this decline in detectable antibodies is not clear since immune correlates of protection for pneumococcal polysaccharide vaccine have not been established and relatively limited clinical data are available regarding the duration of vaccine-induced protection against IPD.Of the 2 observational studies that evaluated the dura-tion of clinical protection induced by PPV23, 1 found that effectiveness declined with age (>65 years) as wellas with increasing time (3–5 years) since vaccination;the other study found that vaccine effectiveness was stable over time (>9 years), although the confidence limits around the point estimates of the vaccine effec-tiveness at different time points were wide.19, 30Revaccination may be needed because PPV23, like other polysaccharide vaccines, is not believed to confer long-lasting protection and because the incidence of pneu-mococcal infection in adults increases substantiallywith age

[Suzan]

We too had low PREVNAR reaction for 11 of the 14 seratypes. Our immunologist wasn't particularly concerned with this despite our pointing out that our dd had been vaccinated 4 times. I think this is sure an interesting coincidence and worth seeing if others have had similar results.

 

Regards,

 

Buster

 

I checked our vaccine reccords this morning and my dd's also were vaccinated 4 times by the age of 1 yr.

 

Susan

[kim]

This looks like it might contain some answers to the things I'm wondering about. Don't have time to pick out what I might be able to understand right now, but wanted to leave it in case someone else has idea's.

 

http://www.clinchem.org/cgi/content/full/53/3/505

 

Bacterial capsular polysaccharides induce antibodies primarily by T cell–independent mechanisms. Therefore, antibody response to most pneumococcal capsular types is generally poor or inconsistent in children aged <2 years whose immune systems are immature. This is the reason why no children aged 2 years or less were included in the control group. The cutoff concentrations proposed in this manuscript are valid for children >4 years of age. To overcome the problem of nonresponsiveness in children younger than 2 years, a conjugated vaccine (Prevnar®) was developed. This contains 2 µg of serotype 4, 9V, 14, 18C, 19F, and 23F and 4 µg of serotype 6B. Use of the conjugated vaccine will have an influence on the choice of serotypes to diagnose specific anti–caps-PS antibody deficiency. Once a patient has been vaccinated with Prevnar, the serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F can no longer be used for antibody measurement, because the evaluation would assess the response to protein antigens rather than to polysaccharide antigens. For patients who have previously been vaccinated with the conjugated vaccine, other serotypes must be chosen. Uddin et al. compared the total pneumococcal IgG antibody, IgG subclass antibody titers, and serotype-specific antibody concentrations (4, 6B, 9V, 14, 18C, 19F, 23F, 1, and 5) in children who had received 2 doses Prevnar followed by a dose of Pneumovax to evaluate the most useful assays in clinical practice (25). They determined that children after Prevnar vaccination produced mostly IgG1 antibodies in contrast to the IgG2 antibody response to natural infection with S. pneumoniae or pneumococcal polysaccharide vaccines. Uddin et al. concluded that serotype-specific IgGs were useful in determining protection against specific pneumococcal strains, and showed that Pneumovax did not broaden protection against non-Prevnar serotypes (25). The increased clinical use of Prevnar and possible use of the next generation conjugated vaccines, such as 9-valent (26)(27)(28) and 11-valent (29), will make it necessary to determine the response to additional serotypes in the future. On the other hand, potential new antigens for vaccine formulations, such as the surface proteins PspA, PspC, PsaA, pneumolysin, BVH-3, and BVH-11, will also need the establishment of reference values.

 

In conclusion, we established reference intervals for the specific antipolysaccharide immune response to 5 serotypes. Among 76 healthy controls (3–30 years of age), 75 adequately responded to at least 2 of these 5 serotypes, and 73 (96%), of the controls responded to at least 3 of these 5 serotypes. Patients who did not respond to at least 4 of the 5 serotypes were diagnosed as nonresponders.

[kim]

Prevnar is bonded with or conjugated to diphtheria CRM197 protein. It is also absorbed on aluminum. This is done to prompt an immune response that wouldn't happen with a polysaccaride vaccine, such as the one discussed in the study above (can you see why it's said that immunization prompts a wholly unnatural immune response! shhhhsh). Depending on what type of test your child is getting, i don't think it would show immunity related to Prevnar vaccination.

 

from above http://www.clinchem.org/cgi/content/full/53/3/505 (bolding and unlderlineine mine)

 

To overcome the problem of nonresponsiveness in children younger than 2 years, a conjugated vaccine (Prevnar®) was developed. This contains 2 µg of serotype 4, 9V, 14, 18C, 19F, and 23F and 4 µg of serotype 6B. Use of the conjugated vaccine will have an influence on the choice of serotypes to diagnose specific anti–caps-PS antibody deficiency. Once a patient has been vaccinated with Prevnar, the serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F can no longer be used for antibody measurement, because the evaluation would assess the response to protein antigens rather than to polysaccharide antigens

 

I think the vaccine Peglem's daughter was given was a polysaccharide vaccine with no aluminum (please correct me if I'm wrong Peg). Sure'em not trying to discredit anyone's Dr. I'm sure they have good explanations for viewing the findings as they are, just trying to figure out if there is significance to the lack of evidence of immunity for Prevnar strains specifically.

[Megs_Mom]

My daugher was vaccinated for Pneumococal 4 times between 2001 - 2003. So if she fails, will that be a true failure? I am failing thus far, to get anyone to run this test for her, and am trying to gather information to convince them. If not, I am considering running myself, but want to be sure that I understand it first.

 

Thanks!

[kim]

Well, rereading what I quoted, I think I'm wrong. I don't think they're saying that it wouldn't dectect antibodies, only that the antibody formation would be due to a different component . Either way, I don't think we have the info that is really needed, which is how long is it reasonable to expect to find antibodies after a full couse of vaccination?