title: Characterization of specific antibody deficiency in adults with medically refractory chronic rhinosinusitis.
abstract: BACKGROUND
  Specific antibody deficiency may predispose patients to recurrent respiratory tract infections. There is limited literature assessing specific antibody deficiency in chronic rhinosinusitis (CRS). This study evaluated the role of specific antibody deficiency in patients with CRS who have failed medical therapy.
  
  
  METHODS
  We performed a retrospective chart review of patients with CRS who underwent functional endoscopic sinus surgery and had prior assessment for humoral immunodeficiency. Each patient's record was reviewed for serum quantitative immunoglobulin G (IgG) and IgA and anti-Streptococcus pneumoniae antibody titers measured at baseline and 6 weeks postvaccination with the 23-valent unconjugated pneumococcal vaccine. Clinical characteristics, including asthma, atopy, and nasal polyps, were recorded.
  
  
  RESULTS
  Of the 129 CRS patients who met inclusion criteria, 93 (72%) had low baseline antipneumococcal titers. Fifteen (11.6%) patients were diagnosed with specific antibody deficiency based on an inadequate response to the pneumococcal polysaccharide vaccine. The group of patients with specific antibody deficiency had significantly lower serum IgA levels when compared with those patients with normal preimmunization titers (138 ± 67.3 versus 330 ± 356; p < 0.05). Patients with specific antibody deficiency had a significantly lower number of preimmunization protective antipneumococcal titers when compared with vaccine responders (1.41 versus 2.72; p < 0.0005).
  
  
  CONCLUSIONS
  This retrospective study indicates that patients with medically refractory CRS may have a high prevalence of low preimmunization antipneumococcal titers and specific antibody deficiency. Furthermore, lower serum IgA levels identified in these specific antibody deficiency patients suggests that a prospective study to further characterize this relationship is warranted.
authors.affiliation: Division of Allergy/Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Tara F
authors.initials: TF
authors.lastname: Carr
authors.forename: Alan P
authors.initials: AP
authors.lastname: Koterba
authors.forename: Rakesh
authors.initials: R
authors.lastname: Chandra
authors.forename: Leslie C
authors.initials: LC
authors.lastname: Grammer
authors.forename: David B
authors.initials: DB
authors.lastname: Conley
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Harris
authors.forename: Robert
authors.initials: R
authors.lastname: Kern
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schleimer
authors.forename: Anju T
authors.initials: AT
authors.lastname: Peters
mesh_terms: D000328:Adult; D000942:Antigens, Bacterial / Q000276:immunology; D001249:Asthma; D001428:Bacterial Vaccines / Q000008:administration & dosage; D002908:Chronic Disease; D005260:Female; D006801:Humans; D056724:Immunity, Humoral; D007070:Immunoglobulin A / Q000097:blood / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps; D012189:Retrospective Studies; D012220:Rhinitis / Q000097:blood / Q000276:immunology* / Q000382:microbiology / Q000503:physiopathology; D012852:Sinusitis / Q000097:blood / Q000276:immunology* / Q000382:microbiology / Q000503:physiopathology; D013296:Streptococcus pneumoniae / Q000276:immunology* / Q000472:pathogenicity; D017211:Treatment Failure
chemical_list: D000942:Antigens, Bacterial; D001428:Bacterial Vaccines; D007070:Immunoglobulin A; D007074:Immunoglobulin G