title: Active vaccination in patients with common variable immunodeficiency (CVID).
abstract: Active vaccination of CVID patients with standard vaccines has rarely been studied in depth although some patients have been shown to develop transient vaccine-specific immunity. We addressed the question whether these patients can be identified by functional classification of their B cell subsets in vitro. Twenty-one CVID patients receiving regular IgG substitution were immunized with anti-peptide and anti-polysaccharide vaccines. Humoral vaccination responses were compared to the numbers of circulating memory B cells, CD21(low) B cells and the capacity to produce antibodies in vitro. Our findings allow four conclusions: (1) positive vaccination responses are not contradictory to the diagnosis of CVID; they occurred against polypeptide vaccines in 23% and against polysaccharide antigens in 18% of all vaccinations. (2) Class-switched antibody responses occur preferentially in patients of CVID group II. (3) A normal percentage of IgM memory B cells is necessary but not sufficient for a vaccination response to polysaccharide antigens. (4) Active vaccination in addition to IgG replacement therapy should be performed in patients of CVID type II - especially in case of vaccines for which passive protection cannot be guaranteed.
authors.affiliation: Department for Rheumatology and Clinical Immunology, University Hospital, Freiburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Goldacker
authors.forename: R
authors.initials: R
authors.lastname: Draeger
authors.forename: K
authors.initials: K
authors.lastname: Warnatz
authors.forename: D
authors.initials: D
authors.lastname: Huzly
authors.forename: U
authors.initials: U
authors.lastname: Salzer
authors.forename: J
authors.initials: J
authors.lastname: Thiel
authors.forename: H
authors.initials: H
authors.lastname: Eibel
authors.forename: M
authors.initials: M
authors.lastname: Schlesier
authors.forename: H H
authors.initials: HH
authors.lastname: Peter
mesh_terms: D000328:Adult; D000368:Aged; D000917:Antibody Formation / Q000276:immunology; D001402:B-Lymphocytes / Q000145:classification / Q000276:immunology*; D017074:Common Variable Immunodeficiency / Q000145:classification / Q000276:immunology* / Q000628:therapy; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007156:Immunologic Memory; D016131:Lymphocyte Subsets / Q000145:classification / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D011134:Polysaccharides / Q000627:therapeutic use*; D013296:Streptococcus pneumoniae / Q000276:immunology; D014611:Vaccination
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M; D010455:Peptides; D022242:Pneumococcal Vaccines; D011134:Polysaccharides