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Clinical Investigations: INFECTION |

Antibody Production Deficiency With Normal IgG Levels in Bronchiectasis of Unknown Etiology*

Montserrat Vendrell, MD; Javier de Gracia, MD, PhD; María-José Rodrigo, MD, PhD; María-Jesús Cruz, MB; Antonio Alvarez, MD; Maria Garcia, MD, PhD; Marc Miravitlles, MD, PhD
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*From the Departments of Pneumology (Dr. Vendrell) and Biostatistics (Dr. Garcia), Hospital Josep Trueta, Girona; and Departments of Pneumology (Drs. de Gracia, Alvarez, and Miravitlles) and Immunology (Drs. Rodrigo and Cruz), Hospital Universitari Vall d’Hebron, Barcelona, Spain.

Correspondence to: Montserrat Vendrell, MD, Ps Canalejas n°1 esc 3 3°1, Girona 17001, Spain, e-mail: mont2188@separ.es



Chest. 2005;127(1):197-204. doi:10.1378/chest.127.1.197
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Background: No defined cause of bronchiectasis is currently found in approximately 50% of cases. Bronchiectasis is a common long-term complication in patients with primary hypogammaglobulinemia.

Study objectives: To ascertain whether antibody production deficiency with normal total serum IgG levels is associated with bronchiectasis.

Design: Antibody response to a pneumococcal unconjugate vaccine and an Haemophilus influenzae type b conjugate vaccine was prospectively studied in all consecutive adult patients with bronchiectasis of unknown etiology who were assessed in our chest outpatient clinic from January 1994 to October 2001. Serum-specific antibodies were measured by enzyme-linked immunosorbent assay, and the results were compared with those obtained in a healthy adult control group. Antibody production deficiency was defined as a failure to respond to either vaccine.

Results: One hundred seven patients were included in the study (mean age, 46.3 years). Antibody production deficiency was diagnosed in 12 patients (11%). A significantly higher incidence of otitis media, lower serum IgG2 subclass levels, and lower preimmunization antibody levels to Streptococcus pneumoniae and H influenzae type b were observed in patients with antibody production deficiency. The probability of antibody production deficiency in patients with a history of otitis media was 20%, 26% in those with low IgG2 subclass levels, and 58% in those with both a history of otitis media and low IgG2 subclass levels.

Conclusions: Antibody production deficiency with normal IgG levels may be associated with bronchiectasis, making it advisable to evaluate the antibody response to both the H influenzae and pneumococcal vaccines in patients with bronchiectasis of unknown etiology, particularly in those with a history of otitis media, low IgG2 subclass levels, and low levels of baseline specific antibodies.

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