From the Section of Allergy, Asthma and Immunology, Children's Mercy Hospital, Kansas City, Missouri.
Center for Medical Informatics and Enterprise Analytics, University of Kansas Medical Center, Kansas City, Kansas.
Allergy Asthma Proc. 2021 Jan 1;42(1):87-92. doi: 10.2500/aap.2021.42.200086.
Specific antibody deficiency is a primary immunodeficiency characterized by normal immunoglobulins with an inadequate response to polysaccharide antigen vaccination. This disease can result in recurrent infections, the most common being sinopulmonary infections. Treatment options include clinical observation, prophylactic antibiotic therapy, and immunoglobulin supplementation therapy, each with limited clinical data about their efficacy. This study aimed to identify whether there was a statistically significant difference in the rate of infections for patients who were managed with clinical observation, prophylactic antibiotics, or immunoglobulin supplementation therapy. A retrospective chart review was conducted. Patients were eligible for the study if they had normal immunoglobulin levels, an inadequate antibody response to polysaccharide antigen-based vaccination, and no other known causes of immunodeficiency. A total of 26 patients with specific antibody deficiency were identified. Eleven patients were managed with immunoglobulin supplementation, ten with clinical observation, and five with prophylactic antibiotic therapy. The frequency of antibiotic prescriptions was assessed for the first year after intervention. A statistically significant rate of decreased antibiotic prescriptions after intervention was found for patients treated with immunoglobulin supplementation (n = ; p = ) and for patients on prophylactic antibiotics (n = ; p = ). There was no statistical difference in antibiotic prescriptions for those patients treated with immunoglobulin supplementation versus prophylactic antibiotics (p = ). Prophylactic antibiotics seemed to be equally effective as immunoglobin supplementation therapy for the treatment of specific antibody deficiency. Further studies are needed in this area.
特异性抗体缺乏症是一种以正常免疫球蛋白和对多糖抗原疫苗接种反应不足为特征的原发性免疫缺陷病。这种疾病可导致反复感染，最常见的是鼻-肺部感染。治疗选择包括临床观察、预防性抗生素治疗和免疫球蛋白补充治疗，每种治疗方法的疗效都有有限的临床数据。本研究旨在确定临床观察、预防性抗生素治疗或免疫球蛋白补充治疗患者的感染率是否存在统计学差异。进行了回顾性图表审查。如果患者具有正常的免疫球蛋白水平、对基于多糖抗原的疫苗接种的抗体反应不足且无其他已知免疫缺陷原因，则有资格入组本研究。共确定了 26 例特异性抗体缺乏症患者。11 例患者接受免疫球蛋白补充治疗，10 例接受临床观察，5 例接受预防性抗生素治疗。评估了干预后第一年的抗生素处方频率。接受免疫球蛋白补充治疗的患者（n = ；p = ）和接受预防性抗生素治疗的患者（n = ；p = ）的抗生素处方减少率有统计学意义。接受免疫球蛋白补充治疗和预防性抗生素治疗的患者的抗生素处方无统计学差异（p = ）。预防性抗生素治疗似乎与免疫球蛋白补充治疗一样有效，可用于治疗特异性抗体缺乏症。这一领域需要进一步研究。
