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Immunoglobulin prophylaxis in patients with antibody deficiency syndromes and anti-IgA antibodies

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Abstract

Sera from three hundred five patients with immunoglobulin deficiencies were analyzed for the presence of anti-IgA antibodies by using indirect agglutination and enzyme-linked immunosorbent assay (ELISA). Anti-IgA antibodies were observed in 15 of 68 (22%) patients with hypogammaglobulinemia and 53 of 185 (29%) patients with selective IgA deficiency, both groups having serum IgA<0.05 g/liter. The highest frequency, 6 of 10 or 60%, was noted for patients with a combined IgA-IgG2 deficiency. No anti-IgA antibodies were detected in 25 patients with serum IgA between 0.05 and 0.27 g/liter and normal amounts of serum IgM and IgG or in 17 patients with hypogammaglobulinemia who had serum IgA of 0.05–0.7 g/liter. The anti-IgA antibodies were primarily of the IgG class, but IgD and IgM anti-IgA were occasionally found. IgE anti-IgA antibodies could not be detected with the presently used technique. The IgG anti-IgA antibodies were mainly of the IgG1 subclass but occasionally also of the subclasses IgG2, IgG3, and IgG4. Of eight patients with anti-IgA antibodies, seven tolerated Ig prophylaxis with a commercial immunoglobulin preparation low in IgA when given either intramuscularly or intravenously. The titers of anti-IgA in the sera of these patients did not rise in relation to the prophylaxis. Only one of the eight patients had a history of previous anaphylactic reactions to IgA-containing blood products. He tolerated six Ig infusions during 5 months with the IgA-depleted preparation without any adverse effects but showed increasing levels of anti-IgA antibodies and ultimately experienced a near-fatal reaction at the seventh infusion.

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Authors and Affiliations

  1. Asthma and Allergy Research Centre, Department of Medicine I, University of Göteborg, 41345, Göteborg, Sweden

    Janne Björkander

  2. Department of Clinical Immunology, Huddinge University Hospital, 10405, Stockholm, Sweden

    Lennart Hammarström & C. I. Edvard Smith

  3. Department of Immunobiology, Wallenberg Laboratory, Karolinska Institute, 10405, Stockholm, Sweden

    Lennart Hammarström & C. I. Edvard Smith

  4. Departments of Pediatrics and Microbiology and Immunology, Duke University Medical Center, 27710, Durham, North Carolina

    Rebecca H. Buckley

  5. Memorial Sloan-Kettering Cancer Institute, 10021, New York, New York

    Charlotte Cunningham-Rundles

  6. Department of Clinical Immunology, University of Göteborg, 41346, Göteborg, Sweden

    Lars Å. Hanson

Authors
  1. Janne Björkander
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  2. Lennart Hammarström
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  3. C. I. Edvard Smith
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  4. Rebecca H. Buckley
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  5. Charlotte Cunningham-Rundles
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  6. Lars Å. Hanson
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Björkander, J., Hammarström, L., Smith, C.I.E. et al. Immunoglobulin prophylaxis in patients with antibody deficiency syndromes and anti-IgA antibodies. J Clin Immunol 7, 8–15 (1987). https://doi.org/10.1007/BF00915419

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  • DOI: https://doi.org/10.1007/BF00915419

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