Low Baseline Pneumococcal Antibody Titers Predict Specific Antibody Deficiency, Increased Upper Respiratory Infections, and Allergy Sensitization

Charles H Song; Dennys Estevez; Diana Chernikova; Francesca Hernandez; Rie Sakai-Bizmark; Richard Stiehm

doi:10.1177/2152656719900338

Low Baseline Pneumococcal Antibody Titers Predict Specific Antibody Deficiency, Increased Upper Respiratory Infections, and Allergy Sensitization

Allergy Rhinol (Providence). 2020 Jan 22:11:2152656719900338. doi: 10.1177/2152656719900338. eCollection 2020 Jan-Dec.

Authors

Charles H Song¹, Dennys Estevez², Diana Chernikova¹, Francesca Hernandez¹, Rie Sakai-Bizmark², Richard Stiehm³

Affiliations

¹ Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California.
² Department of Pediatrics, Harbor-UCLA Research and Education Institute, Torrance, California.
³ Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, California.

Abstract

Background: Inadequate titers of pneumococcal antibody (PA) are commonly present among patients with recurrent respiratory infections.

Objective: We sought to determine the effect of the degree of inadequacy in baseline PA titers on the subsequent polysaccharide vaccine response, the incidence of sinusitis, and allergic conditions.

Methods: A total of 313 patients aged 6 to 70 years with symptoms of recurrent respiratory infections were classified by baseline-pPA (percentage of protective [≥1.3 µg/mL] PA serotypes/total tested serotypes) and postvaccination pPA (post-pPA): Group A (adequate baseline-pPA), Group B (inadequate baseline-pPA, adequate post-pPA, responders), and Group C (inadequate baseline-pPA, inadequate postpPA, nonresponders, specific antibody deficiency [SAD]). Immunity against Streptococcus pneumoniae was defined as adequate when the pPA was ≥70%. Each group and combined groups, Group AB (inadequate baseline-pPA), and Group BC (adequate post-pPA) were analyzed for demographics, history of sinusitis, recurrent sinusitis in the following year, allergic conditions, and association with inadequate individual serotype titers.

Results: Over 80% of patients with respiratory symptoms had inadequate baseline-pPA. Baseline-pPA and SAD prevalence are inversely related (odds ratio = 2.02, 95% CI: 1.15-3.57, P = .01). Inadequate serotype 3 antibody titer is highly associated with SAD (odds ratio = 2.02, 96% CI: 1.61-5.45, P < .01). The groups with inadequate pPA (Group B and C, or BC) had significantly higher percentage of patients with chronic rhinosinusitis (P < .001), allergic sensitization, and allergic rhinitis (P < .05). Group A contained higher percentage of patients with recurrent upper airway infections (P < .001).

Conclusion: Low baseline-pPA and low antibody titers to serotype 3 are highly associated with SAD, increased incidence of respiratory infections including CRS and allergic conditions.

Keywords: allergic rhinitis; asthma; chronic rhinosinusitis; immune deficiency; recurrent respiratory infection; sinusitis; specific antibody deficiency.