Frequency of Low Immunglobuline level in Pre-School Recurrent Wheezing

Yıl 2023, Cilt: 17 Sayı: 6, 439 - 444, 27.11.2023

Merve Yoldaş Çelik İlknur Külhaş Çelik Tayfur Giniş Betül Büyüktiryaki Muge Toyran Emine Dibek Mısırlıoğlu Can Naci Kocabaş Ersoy Civelek

https://doi.org/10.12956/tchd.1268678

Öz

Objective: Immunoglobulin lowering may be associated with recurrent wheezing symptoms and clinic by increasing the tendency to viral respiratory tract infections. This study aimed to investigate the frequency of immunoglobulinemia in preschoolers with wheezing.

Material and Methods: The study was conducted between 01.01.2013 - 01.01.2016 between T.C. University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training, and Research Hospital, The Pediatric Allergy and Immunology Clinic included patients who had been followed up and treated for at least one year with recurrent wheezing attacks within 72 months. The patients’ immunoglobulin (G, A, M) values were retrospectively analyzed. Immunoglobulin levels were determined to be normal and low according to age limits.

Results: The study included 585 patients (65.6% male, 34.4% female) under the age of 6 years with a mean age of 26.9 months. The mean follow-up period of the patients is 2.2 years. In 33.7% of these patients, at least one immunoglobulin was low. None of these patients had any signs or symptoms of immunodeficiency. Immunoglobulin A was low in 21% of the patients, immünglobulin G in 18%, and immünglobulin M in 7.5% of all patients.

Conclusion: Hypogammaglobulinemia was found in approximately 1/3 of the patients. There were no signs of immunodeficiency in these patients. Whether this is a special group in preschooler recurrent wheezing and hypogammaglobulinemia combination should be etiologically investigated.

Anahtar Kelimeler

pre-school recurrent wheezing, low immunoglobulin, immunoglobulin M, immunoglobulin A, immunoglobulin G

Okul Öncesi Tekrarlayan Vizing ile İzlenen Hastalarda İmmünglobulin Düşüklüğü Sıklığı

Öz

Amaç: İmmünglobulin düşüklüğü viral solunum yolu enfeksiyonlarına eğilimi arttırarak tekrarlayan vizing semptomları ve kliniği ile ilişki olabilir. Bu çalışmada okul öncesi vizingli hastalarda immünglobulin düşüklüğü sıklığını araştırmak amaçlandı.

Gereç ve Yöntemler: Çalışmaya 01.01.2013 - 01.01.2016 tarihleri arasında T.C. Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi Çocuk Allerji ve İmmünoloji Kliniği’nde 72 ay altında tekrarlayan vizing ataklarıyla en az bir yıldır takip ve tedavi edilen hastalar dahil edildi. Hastaların immünglobulin (G,A,M) değerleri geriye dönük olarak incelendi. İmmünglobulin düzeyleri yaş sınırlarına göre normal ve düşük olarak belirlendi.

Bulgular: Çalışmada ortalama başvuru yaşı 26.9 ay olan 6 yaş altı 585 (%65.6 erkek, %34.4 kız) hasta dahil edilmiştir. Hastaların ortalama takip süresi 2.2 yıldır. Bu hastaların %33.7 sinde en az bir immünglobulinde düşüklük saptanmıştır. Bu hastaların hiçbirinde immün yetmezlik düşündürecek semptom ve bulgular saptanmamıştır. Tüm hastaların %21’inde immünglobulin A, %18’inde immünglobulin G, %7.5’inde immünglobulin M değerlerinde düşüklük olduğu saptanmıştır.

Sonuç: Hastaların yaklaşık 1/3’ünde hipogamaglobulinemi saptandı. Bu hastalarda immün yetmezlik belirtileri yoktu. Okul öncesi tekrarlayan hışıltı ve hipogamaglobulinemi kombinasyonu saptanan hastaların özel bir grup olup olmadığı konusunda araştırmalar yapılmalıdır.

Anahtar Kelimeler

okul öncesi tekrarlayan vizing, düşük immunglobulin, immunglobulin G, immunglobulin M, immunglobulin A

Kaynakça

• Bloom CI, Franklin C, Bush A, Saglani S, Quint JK. Burden of preschool wheeze and progression to asthma in the UK: Population-based cohort 2007 to 2017. J Allergy Clin Immunol 2021;147:1949-58.
• Fitzpatrick AM, Bacharier LB, Guilbert TW, Jackson DJ, Szefler SJ, Beigelman A, et al. Phenotypes of recurrent wheezing in preschool children: identification by latent class analysis and utility in prediction of future exacerbation. J Allergy Clin Immunol Pract 2019;7:915-24. e7.
• Civelek E, Cakir B, Boz AB, Yuksel H, Orhan F, Uner A, et al. Extent and burden of allergic diseases in elementary schoolchildren: a national multicenter study. J Investig Allergol Clin Immunol 2010;20:280-8.
• Justiz Vaillant AA, Wilson AM. Transient Hypogammaglobulinemia of Infancy. 2022 Sep 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
• Ameratunga R, Ahn Y, Steele R, Woon S. Transient hypogammaglobulinaemia of infancy: many patients recover in adolescence and adulthood. Clin Exp Immunol 2019 ;198:224-32.
• Yorulmaz A, Artaç H, Reisli İ. Evaluation of patient follow-up with transient hypogammaglobulinemia in infancy diagnosis. Çağdaş Tıp Dergisi 2019;9:15-20.
• Kim JH, Ye YM, Ban GY, Shin YS, Lee HY, Nam YH, et al. Effects of immunoglobulin replacement on asthma exacerbation in adult asthmatics with IgG subclass deficiency. Allergy Asthma Immunol Res 2017;9:526-33.
• Berger M, Geng B, Cameron DW, Murphy LM, Schulman ES. Primary immune deficiency diseases as unrecognized causes of chronic respiratory disease. Respir Med 2017;132:181-8.
• de Fays C, Carlier FM, Gohy S, Pilette C. Secretory Immunoglobulin A Immunity in Chronic Obstructive Respiratory Diseases. Cells 2022;11:1324.
• Karaman Ö, Uğuz A, Uzuner N. IgG subclasses in wheezing infants. Indian J Pediatr 1999;66:345-9.
• Frey A, Lunding LP, Ehlers JC, Weckmann M, Zissler UM, Wegmann M. More than just a barrier: the immune functions of the airway epithelium in asthma pathogenesis. Front Immunol 2020;11:761.
• Aghamohammadi A, Cheraghi T, Gharagozlou M, Movahedi M, Rezaei N, Yeganeh M, et al. IgA deficiency: correlation between clinical and immunological phenotypes. J Clin Immunol 2009;29:130-6.
• Urschel S, Kayikci L, Wintergerst U, Notheis G, Jansson A, Belohradsky BH. Common variable immunodeficiency disorders in children: delayed diagnosis despite typical clinical presentation. J Pediatr 2009;154:888-94.
• Haskoloğlu ZŞ. To What Extent do Transient Hypogammaglobulinemia of the Infancy and Allergic Diseases Coexist? Asthma Allergy Immunol 2020;18:23-9.
• Tezcan I, Berkel A, Ersoy F, Sanal O. Sağlıklı Türk çocukları ve erişkinlerde turbidometrik yöntemle bakılan serum immunoglobulin düzeyleri. Çocuk Sağlığı ve Hastalıkları Dergisi 1996;39:649-56.
• de Moraes Lui C, Oliveira LC, Diogo CL, Kirschfink M, Grumach AS. Immunoglobulin G subclass concentrations and infections in children and adolescents with severe asthma. Pediatr Allergy Immunol 2002;13:195-202.
• Erkoçoğlu M, Metin A, Kaya A, Özcan C, Akan A, Civelek E, et al. Allergic and autoimmune disorders in families with selective IgA deficiency. Turk J Med Sci 2017;47:592-8.
• Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. . Available from: wwwginasthmaorg. 2021.
• Kaufman HS, Hobbs JR. Immunoglobulin deficiencies in an atopic population. Lancet 1970;2:1061-3.
• Aksu G, Genel F, Koturoğlu G, Kurugöl Z, Kütükçüler N. Serum immunoglobulin (IgG, IgM, IgA) and IgG subclass concentrations in healthy children: a study using nephelometric technique. Turk J Pediatr 2006;48:19-24.
• Hand TW, Reboldi A. Production and Function of Immunoglobulin A. Annu Rev Immunol 2021;39:695-718.
• Frey A, Lunding LP, Ehlers JC, Weckmann M, Zissler UM, Wegmann M. More Than Just a Barrier: The Immune Functions of the Airway Epithelium in Asthma Pathogenesis. Front Immunol 2020;11:761.
• Ladjemi MZ, Gras D, Dupasquier S, Detry B, Lecocq M, Garulli C, et al. Bronchial epithelial IgA secretion is impaired in asthma. Role of IL-4/IL-13. Am J Respir Crit Care Med 2018;197:1396-409.
• Mosconi E, Rekima A, Seitz-Polski B, Kanda A, Fleury S, Tissandie E, et al. Breast milk immune complexes are potent inducers of oral tolerance in neonates and prevent asthma development. Mucosal Immunol 2010;3:461-74.
• Järvinen KM, Martin H, Oyoshi MK. Immunomodulatory effects of breast milk on food allergy. Ann Allergy Asthma Immunol 2019;123:133-43.
• Sandin A, Björkstén B, Böttcher MF, Englund E, Jenmalm MC, Bråbäck L. High salivary secretory IgA antibody levels are associated with less late-onset wheezing in IgE-sensitized infants. Pediatr Allergy Immunol 2011;22:477-81.
• El Ansari YS, Kanagaratham C, Burton OT, Santos JV, Hollister BA, Lewis OL, et al. Allergen-Specific IgA Antibodies Block IgE-Mediated Activation of Mast Cells and Basophils. Front Immunol 2022;13:881655.
• Kukkonen K, Kuitunen M, Haahtela T, Korpela R, Poussa T, Savilahti E. High intestinal IgA associates with reduced risk of IgE-associated allergic diseases. Pediatr Allergy Immunol 2010;21:67-73.
• de Fays C, Carlier FM, Gohy S, Pilette C. Secretory immunoglobulin a immunity in chronic obstructive respiratory diseases. Cells 2022;11:1324.
• Lúdvíksson BR, Arason GJ, Thorarensen O, Ardal B, Valdimarsson H. Allergic diseases and asthma in relation to serum immunoglobulins and salivary immunoglobulin A in pre-school children: a follow-up community-based study. Clin Exp Allergy 2005;35:64-9.
• Jones K, Savulescu AF, Brombacher F, Hadebe S. Immunoglobulin M in Health and Diseases: How Far Have We Come and What Next? Frontiers in Immunology 2020;11: 595535.
• Michaud E, Mastrandrea C, Rochereau N, Paul S. Human Secretory IgM: An Elusive Player in Mucosal Immunity. Trends Immunol 2020;41:141-56.
• Bayram RO, Özdemir H, Emsen A, DAĞI HT, Artac H. Reference ranges for serum immunoglobulin (IgG, IgA, and IgM) and IgG subclass levels in healthy children. Turk J Med Sci 2019;49:497-505.
• Oner AF, Caksen H, Celik A, Cesur Y, Uner A, Arslan S. Serum immunoglobulins and immunoglobulin G subclasses with recurrent wheezing. Indian J Pediatr 2000;67:861-4.
• Ones U, Güler N, Somer A, Salman N, Yalçin I. Low immunoglobulin G3 levels in wheezy children. Acta Paediatr 1998;87:368-70.
• Zaitsu M, Matsuo M. Transient low IgG4 levels cause recurrent wheezing requiring multiple hospitalizations in infancy. Pediatr Pulmonol 2022;57:1631-4.
• Kim CK, Park JS, Chu SY, Kwon E, Kim H, Callaway Z. Low immunoglobulin G4 subclass level is associated with recurrent wheezing in young children. Asia Pacific Allergy 2020;10:e43.