Chest
Volume 116, Issue 4, October 1999, Pages 946-952
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Clinical Investigations
AIRWAY DISEASE
Specific Antibody Response Against the 23-Valent Pneumococcal Vaccine in Patients With α1-Antitrypsin Deficiency With and Without Bronchiectasis

https://doi.org/10.1378/chest.116.4.946Get rights and content

Objective

To assess the specific antibody response against polyvalent pneumococcal vaccine in patients withα 1-antitrypsin deficiency (AATD) and respiratory infections.

Design and participants

We investigated specific IgG, IgG1, and IgG2 antibody responses against the 23-valent antipneumococcal vaccine in 18 patients with AATD phenotype PiZZ, 9 of whom had bronchiectasis and 4 a history of recurrent pneumonia, and compared them with a control group of 40 healthy volunteers.

Interventions

Blood samples were drawn just prior to and 3 weeks after immunization.

Measurements and results

Quantification of specific IgG and its subclasses was performed by an enzyme-linked immunosorbent assay. For patients with AATD, mean increases in specific antipneumococcal titers were 4.7-fold (25 to 75% quartiles, 2.5- to 6.8-fold) for total IgG, 3.2-fold (1.2- to 4.9-fold) for IgG1, and 2.1-fold (1.8- to 3.7-fold) for IgG2. For the control group, the values were 3.3-fold (1.8- to 5.8-fold) for total IgG, 2.5-fold (1.9- to 3.4-fold) for IgG1, and 3.1-fold (1.9- to 4.5-fold) for IgG2; differences were not significant. Patients with bronchiectasis showed a tendency toward higher levels of IgG subclasses than both control subjects and patients without bronchiectasis; however, there was a tendency toward lower postvaccination serum levels of specific antipneumococcal IgG, IgG1, and IgG2 in patients with bronchiectasis compared with patients without bronchiectasis, but this trend did not reach statistical significance. Three of the four patients with recurrent pneumonia did not show an appropriate IgG2 response.

Conclusions

These results suggest that, as a group, patients with AATD have a preserved antibody response against pneumococcal polysaccharides. Patients with bronchiectasis show a tendency toward a decreased antibody response, even with increased serum levels of most Ig types. Individuals with an impaired IgG2 response seem to be at increased risk of recurrent pneumonia. Considering the pernicious effect of pulmonary infections on these patients and the preserved antibody response in a majority of them, pneumococcal vaccination should be recommended to patients with AATD.

Section snippets

Study Population

The study population consisted of patients with severe AATD, phenotype PiZZ, seen at our center.

Their results were compared with those of a control group comprised of 40 healthy, nonrelated volunteers (20 women, 20 men; age range, 21 to 48 years; mean age, 30 years), whose characteristics have been described previously.11

None of the patients in either group had a history of prior pneumococcal immunization or known immunodeficiency. All subjects gave informed consent, and the study was approved

Patient Characteristics

The characteristics of the study population consisting of 18 AATD individuals with the PiZZ phenotype are shown in Tables 1and 2 . On CT examination, 15 had pulmonary emphysema and nine had bronchiectasis. Fourteen (78%) suffered from recurrent exacerbations with increased dyspnea, sputum volume, and sputum purulence. Six patients (33%) had a history of previous pneumonia, which was recurrent in four (one of them with small diffuse bronchiectasis). Eight patients were receiving augmentation

Discussion

Patients with AATD often develop infectious respiratory complications. Half of the patients described here had bronchiectasis seen on CT examination. One third had a history of documented pneumonia, which was recurrent in four cases. The majority (14/18; 78%) frequently experienced infectious exacerbations of their COPD.

However, the specific IgG, IgG1, and IgG2 antipneumococcal antibody responses in most patients with AATD did not differ significantly from the responses observed in healthy

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