title: Immunoglobulins and immunoglobulin subclasses in the elderly.
abstract: BACKGROUND
  Published data imply that adult concentrations are achieved for all Ig isotypes and plateau by 15-18 years of age. Recent data, however, suggest that these results are not applicable in the elderly. There are no equivalent data for IgG subclasses. We present reference range data for an elderly UK patient population, for IgG, IgA, IgM and IgG subclasses.
  
  
  METHODS
  Serum immunoglobulins were reviewed on samples from 1146 patients > 60 years of age and 925 patients aged 18-60 years. Serum IgG subclasses were reviewed on samples from 498 patients >60 years and 484 patients aged 18-60 years. All Igs and subclasses were measured by nephelometry. Reference ranges were derived by probability plotting.
  
  
  RESULTS
  Serum median IgG and IgM concentrations are reduced in the elderly (IgG female P < 0.001, IgG male P < 0.03; IgM female P < 0.001, IgM male P < 0.001). Serum IgA concentrations are maintained. Indeed, men showed a slight increase in serum IgA with age (P = 0.03). Few differences dependent on gender were seen. Median IgM was lower in men in the younger age groups (18-60 years P < 0.001; 61-70 years P = 0.017). IgG(2) is reduced in elderly men (P = 0.002) and IgG, reduced in elderly women (P = 0.009).
  
  
  CONCLUSIONS
  We advocate that centres offering these investigations provide local, method-dependent reference ranges, and suggest an approach as to how this might be achieved.
authors.affiliation: Immunology and Immunogenetics, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Lock
authors.forename: D J
authors.initials: DJ
authors.lastname: Unsworth
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007136:Immunoglobulins / Q000737:chemistry* / Q000145:classification; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012737:Sex Factors
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007136:Immunoglobulins