The role of anti-IgA antibodies in causing adverse reactions to gamma globulin infusion in immunodeficient patients: A comprehensive review of the literature
2011; Elsevier BV; Volume: 129; Issue: 3 Linguagem: Inglês
10.1016/j.jaci.2011.06.047
ISSN1097-6825
AutoresRima Rachid, Francisco A. Bonilla,
Tópico(s)Platelet Disorders and Treatments
ResumoAnaphylactic reactions to immunoglobulin infusions in immunodeficient patients with undetectable IgA have been attributed in several reports to IgG or IgE anti-IgA antibodies. However, other reports have not supported an association between such antibodies and the development of severe reactions. We have reviewed the articles reporting reactions to immunoglobulin products in IgA-deficient patients, as well as those describing the presence of such antibodies in the absence of reactions to infusions. A variety of factors might influence the association of adverse reactions with anti-IgA antibodies, including the serum concentration and isotype (IgG or IgE) of the anti-IgA antibody, its specificity (class or subclass specific), the method of measurement, and the IgA content of the gamma globulin infusion and its route of administration. The role of anti-IgA antibodies in causing anaphylaxis in IgA-deficient patients receiving gamma globulin therapy is still controversial. Larger (multicenter) studies are needed to further evaluate this association. Anaphylactic reactions to immunoglobulin infusions in immunodeficient patients with undetectable IgA have been attributed in several reports to IgG or IgE anti-IgA antibodies. However, other reports have not supported an association between such antibodies and the development of severe reactions. We have reviewed the articles reporting reactions to immunoglobulin products in IgA-deficient patients, as well as those describing the presence of such antibodies in the absence of reactions to infusions. A variety of factors might influence the association of adverse reactions with anti-IgA antibodies, including the serum concentration and isotype (IgG or IgE) of the anti-IgA antibody, its specificity (class or subclass specific), the method of measurement, and the IgA content of the gamma globulin infusion and its route of administration. The role of anti-IgA antibodies in causing anaphylaxis in IgA-deficient patients receiving gamma globulin therapy is still controversial. Larger (multicenter) studies are needed to further evaluate this association. There are 2 subclasses of IgA (IgA1 and IgA2) in human subjects. Furthermore, there are 2 allotypes of IgA2 (IgA2m1 and IgA2m2). The normal adult serum IgA level ranges between approximately 70 and 300 mg/dL. The clinical definition of IgA deficiency varies among reports and usually ranges between less than approximately 5 to 10 mg/dL.1Bonilla F.A. Bernstein I.L. Khan D.A. Ballas Z.K. Chinen J. Frank M.M. et al.Practice parameter for the diagnosis and management of primary immunodeficiency.Ann Allergy Asthma Immunol. 2005; 94: S1-S63Abstract Full Text PDF PubMed Scopus (453) Google Scholar However, approximately 25% of these subjects have levels of IgA that are measurable by using more sensitive methods; the remainder are completely lacking IgA.2Vyas G.N. Perkins H.A. Yang Y.M. Basantani G.K. Healthy blood donors with selective absence of immunoglobulin A: prevention of anaphylactic transfusion reactions caused by antibodies to IgA.J Lab Clin Med. 1975; 85: 838-842PubMed Google Scholar In this review the term IgA deficiency refers to a level less than the detectable clinical range. This degree of IgA deficiency was found in 0.03% to 0.3% of healthy subjects (1:3,333 to 1:328) in the United States in 4 large prevalence studies including between 3,024 and 73,569 subjects each, although the definition of IgA deficiency was not consistent across all studies (range, 1-10 mg/dL).2Vyas G.N. Perkins H.A. Yang Y.M. Basantani G.K. Healthy blood donors with selective absence of immunoglobulin A: prevention of anaphylactic transfusion reactions caused by antibodies to IgA.J Lab Clin Med. 1975; 85: 838-842PubMed Google Scholar, 3Clark J.A. Callicoat P.A. Brenner N.A. Bradley C.A. Smith Jr., D.M. Selective IgA deficiency in blood donors.Am J Clin Pathol. 1983; 80: 210-213Crossref PubMed Scopus (96) Google Scholar, 4Cassidy J.T. Burt A. Petty R. Sullivan D. Selective IgA deficiency in connective tissue diseases.N Engl J Med. 1969; 280: 275PubMed Google Scholar, 5Cassidy J.T. Nordby G.L. Human serum immunoglobulin concentrations: prevalence of immunoglobulin deficiencies.J Allergy Clin Immunol. 1975; 55: 35-48Abstract Full Text PDF PubMed Scopus (87) Google Scholar, 6Sandler S.G. Eckrich R. Malamut D. Mallory D. Hemagglutination assays for the diagnosis and prevention of IgA anaphylactic transfusion reactions.Blood. 1994; 84: 2031-2035PubMed Google Scholar A similar range of prevalence has been found in 8 additional reports from the United Kingdom, Scandinavia, and Australia.3Clark J.A. Callicoat P.A. Brenner N.A. Bradley C.A. Smith Jr., D.M. Selective IgA deficiency in blood donors.Am J Clin Pathol. 1983; 80: 210-213Crossref PubMed Scopus (96) Google Scholar Life-threatening reactions to administration of human IgG are rare in clinical practice.7Brennan V.M. Salome-Bentley N.J. Chapel H.M. Prospective audit of adverse reactions occurring in 459 primary antibody-deficient patients receiving intravenous immunoglobulin.Clin Exp Immunol. 2003; 133: 247-251Crossref PubMed Scopus (117) Google Scholar In 1968, Vyas et al8Vyas G.N. Perkins H.A. Fudenberg H.H. Anaphylactoid transfusion reactions associated with anti-IgA.Lancet. 1968; 2: 312-315Abstract PubMed Google Scholar reported the first anaphylactic reaction associated with intravenous infusion of a commercial gamma globulin product in a patient lacking serum IgA who had IgG anti-IgA antibodies. (In this review the term anaphylaxis is used for severe life-threatening systemic hypersensitivity reactions that might or might not be IgE mediated, as recommended in the Revised Nomenclature for Allergy for Global Use.9Johansson S.G. Bieber T. Dahl R. Friedmann P.S. Lanier B.Q. Lockey R.F. et al.Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003.J Allergy Clin Immunol. 2004; 113: 832-836Abstract Full Text Full Text PDF PubMed Scopus (1937) Google Scholar) Since that time, there have been several reports of anaphylactic reactions to immunoglobulin infusions in immunodeficient patients with undetectable IgA that were attributed to IgG or IgE anti-IgA antibodies.10Cunningham-Rundles C. Wong S. Bjorkander J. Hanson L.A. Use of an IgA-depleted intravenous immunoglobulin in a patient with an anti-IgA antibody.Clin Immunol Immunopathol. 1986; 38: 141-149Crossref PubMed Scopus (16) Google Scholar, 11Burks A.W. Sampson H.A. Buckley R.H. Anaphylactic reactions after gamma globulin administration in patients with hypogammaglobulinemia. Detection of IgE antibodies to IgA.N Engl J Med. 1986; 314: 560-564Crossref PubMed Scopus (314) Google Scholar, 12Horn J. Thon V. Bartonkova D. Salzer U. Warnatz K. Schlesier M. et al.Anti-IgA antibodies in common variable immunodeficiency (CVID): diagnostic workup and therapeutic strategy.Clin Immunol. 2007; 122: 156-162Crossref PubMed Scopus (68) Google Scholar, 13Eijkhout H.W. van den Broek P.J. van der Meer J.W. Substitution therapy in immunodeficient patients with anti-IgA antibodies or severe adverse reactions to previous immunoglobulin therapy.Neth J Med. 2003; 61: 213-217PubMed Google Scholar However, other reports have not supported an association between such antibodies and the development of severe reactions.14Koistinen J. Heikkila M. Leikola J. Gammaglobulin treatment and anti-IgA antibodies in IgA-deficient patients.BMJ. 1978; 2: 923-924Crossref PubMed Scopus (21) Google Scholar, 15Ferreira A. Garcia Rodriguez M.C. Fontan G. Follow-up of anti-IgA antibodies in primary immunodeficient patients treated with gamma-globulin.Vox Sang. 1989; 56: 218-222Crossref PubMed Scopus (14) Google Scholar Consequently, the significance of anti-IgA antibodies is still controversial. Nevertheless, as a result of these reports, virtually all gamma globulin products carry a warning advising caution when administering to IgA-deficient patients or even listing this condition as a contraindication for product administration. Anti-IgA antibodies that bind to all forms of IgA are designated class specific, and those that bind to 1 subclass or 1 allotype are designated limited specificity or subclass specific.16Koistinen J. Cardenas R.M. Fudenberg H.H. Anti-IgA antibodies of limited specificity in healthy IgA deficient subjects.J Immunogenet. 1977; 4: 295-300Crossref PubMed Scopus (18) Google Scholar, 17de Albuquerque Campos R. Sato M.N. da Silva Duarte A.J. IgG anti-IgA subclasses in common variable immunodeficiency and association with severe adverse reactions to intravenous immunoglobulin therapy.J Clin Immunol. 2000; 20: 77-82Crossref PubMed Scopus (59) Google Scholar A variety of methods have been applied for measurement of anti-IgA antibodies. These include passive hemagglutination (PHA),8Vyas G.N. Perkins H.A. Fudenberg H.H. Anaphylactoid transfusion reactions associated with anti-IgA.Lancet. 1968; 2: 312-315Abstract PubMed Google Scholar ELISA,11Burks A.W. Sampson H.A. Buckley R.H. Anaphylactic reactions after gamma globulin administration in patients with hypogammaglobulinemia. Detection of IgE antibodies to IgA.N Engl J Med. 1986; 314: 560-564Crossref PubMed Scopus (314) Google Scholar RIA,18Nadorp J.H. Voss M. Buys W.C. van Munster P.J. van Tongeren J.H. Aalberse R.C. et al.The significance of the presence of anti-IgA antibodies in individuals with an IgA deficiency.Eur J Clin Invest. 1973; 3: 317-323Crossref PubMed Scopus (52) Google Scholar immunoradiometric assay (IRMA),19Homburger H.A. Smith J.R. Jacob G.L. Laschinger C. Naylor D.H. Pineda A.A. Measurement of anti-IgA antibodies by a two-site immunoradiometric assay.Transfusion. 1981; 21: 38-44Crossref PubMed Scopus (14) Google Scholar particle gel immunoassay,20Salama A. Schwind P. Schonhage K. Genth R. Cotting C. Hustinx H. et al.Rapid detection of antibodies to immunoglobulin A molecules by using the particle gel immunoassay.Vox Sang. 2001; 81: 45-48Crossref PubMed Scopus (30) Google Scholar membrane immunoassay (MIA), and flow cytometry–based fluorescent bead immunoassays.21Rumilla K.M. Winters J.L. Peterman J.M. Jedynak E.A. Homburger H.A. Development and validation of a fluorescent microsphere immunoassay for anti-IgA.Immunohematology. 2009; 25: 24-28PubMed Google Scholar A variety of factors might influence the association of adverse reactions with anti-IgA antibodies, including the serum concentration and isotype (IgG or IgE) of the anti-IgA antibody, its specificity (class or subclass specific), the method of measurement, the characteristics of the IgG product (IgA content), and the route of administration (intramuscular, intravenous, or subcutaneous). We have reviewed reports of reactions to gamma globulin products in IgA-deficient patients. We performed a PubMed search using combinations of key words, such as "IgA-deficient," "IgA deficiency," "anti-IgA antibody(ies)," "immunoglobulin infusion," "gamma globulin," "reaction," "anaphylaxis," and "anaphylactoid." We identified additional pertinent literature in the references of these reports. We reviewed all articles we found since 1968, when the first reaction was described by Vyas et al.8Vyas G.N. Perkins H.A. Fudenberg H.H. Anaphylactoid transfusion reactions associated with anti-IgA.Lancet. 1968; 2: 312-315Abstract PubMed Google Scholar We have omitted reports that focus exclusively on reactions to other blood products. Among studies evaluating between 19 and 358 IgA-deficient subjects each, class-specific IgG anti-IgA was detected in 24% to 32%. Class-specific IgG anti-IgA was not found in 333 subjects with detectable IgA.2Vyas G.N. Perkins H.A. Yang Y.M. Basantani G.K. Healthy blood donors with selective absence of immunoglobulin A: prevention of anaphylactic transfusion reactions caused by antibodies to IgA.J Lab Clin Med. 1975; 85: 838-842PubMed Google Scholar, 6Sandler S.G. Eckrich R. Malamut D. Mallory D. Hemagglutination assays for the diagnosis and prevention of IgA anaphylactic transfusion reactions.Blood. 1994; 84: 2031-2035PubMed Google Scholar However, in one other report class-specific anti-IgA was present in 17% of 58 IgA-deficient blood donors, in 3 (2%) of 142 non–IgA-deficient (pregnant and nonpregnant) women, and in 1 (0.5%) of 200 non–IgA-deficient blood donors.22Petty R.E. Sherry D.D. Johannson J. Anti-IgA antibodies in pregnancy.N Engl J Med. 1985; 313: 1620-1625Crossref PubMed Scopus (30) Google Scholar Note that in this report a titer as low as 1:4 determined by using the PHA method was considered positive. Subclass-specific IgG anti-IgA antibodies have been found in 5% to 7% of IgA-deficient blood donors,3Clark J.A. Callicoat P.A. Brenner N.A. Bradley C.A. Smith Jr., D.M. Selective IgA deficiency in blood donors.Am J Clin Pathol. 1983; 80: 210-213Crossref PubMed Scopus (96) Google Scholar, 16Koistinen J. Cardenas R.M. Fudenberg H.H. Anti-IgA antibodies of limited specificity in healthy IgA deficient subjects.J Immunogenet. 1977; 4: 295-300Crossref PubMed Scopus (18) Google Scholar, 22Petty R.E. Sherry D.D. Johannson J. Anti-IgA antibodies in pregnancy.N Engl J Med. 1985; 313: 1620-1625Crossref PubMed Scopus (30) Google Scholar as well as 6% of non–IgA-deficient subjects.22Petty R.E. Sherry D.D. Johannson J. Anti-IgA antibodies in pregnancy.N Engl J Med. 1985; 313: 1620-1625Crossref PubMed Scopus (30) Google Scholar Rivat et al23Rivat L. Rivat C. Daveau M. Ropartz C. Comparative frequencies of anti-IgA antibodies among patients with anaphylactic transfusion reactions and among normal blood donors.Clin Immunol Immunopathol. 1977; 7: 340-348Crossref PubMed Scopus (29) Google Scholar found subclass-specific IgG anti-IgA by means of PHA in as many as 59% of 1010 blood donors. The reason for such a high frequency is unclear, but the authors speculated it could be because they included PHA titers of less than 1:8. Three studies including a total of 325 immunodeficient (common variable immunodeficiency [CVID], IgG2 subclass deficiency (IGG2D), and selective IgA deficiency [SIGAD]) patients lacking IgA found 99 (30%) patients with IgG anti-IgA antibodies.18Nadorp J.H. Voss M. Buys W.C. van Munster P.J. van Tongeren J.H. Aalberse R.C. et al.The significance of the presence of anti-IgA antibodies in individuals with an IgA deficiency.Eur J Clin Invest. 1973; 3: 317-323Crossref PubMed Scopus (52) Google Scholar, 24Bjorkander J. Hammarstrom L. Smith C.I. Buckley R.H. Cunningham-Rundles C. Hanson L.A. Immunoglobulin prophylaxis in patients with antibody deficiency syndromes and anti-IgA antibodies.J Clin Immunol. 1987; 7: 8-15Crossref PubMed Scopus (89) Google Scholar, 25Ferreira A. Garcia Rodriguez M.C. Lopez-Trascasa M. Pascual Salcedo D. Fontan G. Anti-IgA antibodies in selective IgA deficiency and in primary immunodeficient patients treated with gamma-globulin.Clin Immunol Immunopathol. 1988; 47: 199-207Crossref PubMed Scopus (51) Google Scholar For most of these, the specificity of the anti-IgA was not determined; only 7 were stated to have class-specific IgG anti-IgA, and no patient with IgA levels of greater than 5 mg/dL had anti-IgA antibodies.18Nadorp J.H. Voss M. Buys W.C. van Munster P.J. van Tongeren J.H. Aalberse R.C. et al.The significance of the presence of anti-IgA antibodies in individuals with an IgA deficiency.Eur J Clin Invest. 1973; 3: 317-323Crossref PubMed Scopus (52) Google Scholar The great majority of those who received immunoglobulin therapy tolerated their infusions (a precise number or fraction could not be determined from the data in the report). After Vyas et al8Vyas G.N. Perkins H.A. Fudenberg H.H. Anaphylactoid transfusion reactions associated with anti-IgA.Lancet. 1968; 2: 312-315Abstract PubMed Google Scholar reported the first IgA-deficient patient with class-specific IgG anti-IgA and anaphylaxis to intramuscular immunoglobulin, several reports described similar patients with moderate symptoms (eg, abdominal pain, myalgia, nausea, fevers, and/or rigors) or anaphylaxis to gamma globulin infusions in the presence of IgG anti-IgA antibodies, which were detected by using different methods. We found reports of 27 patients with such presentations, the characteristics of whom are listed in Table I.8Vyas G.N. Perkins H.A. Fudenberg H.H. Anaphylactoid transfusion reactions associated with anti-IgA.Lancet. 1968; 2: 312-315Abstract PubMed Google Scholar, 10Cunningham-Rundles C. Wong S. Bjorkander J. Hanson L.A. Use of an IgA-depleted intravenous immunoglobulin in a patient with an anti-IgA antibody.Clin Immunol Immunopathol. 1986; 38: 141-149Crossref PubMed Scopus (16) Google Scholar, 11Burks A.W. Sampson H.A. Buckley R.H. Anaphylactic reactions after gamma globulin administration in patients with hypogammaglobulinemia. Detection of IgE antibodies to IgA.N Engl J Med. 1986; 314: 560-564Crossref PubMed Scopus (314) Google Scholar, 12Horn J. Thon V. Bartonkova D. Salzer U. Warnatz K. Schlesier M. et al.Anti-IgA antibodies in common variable immunodeficiency (CVID): diagnostic workup and therapeutic strategy.Clin Immunol. 2007; 122: 156-162Crossref PubMed Scopus (68) Google Scholar, 13Eijkhout H.W. van den Broek P.J. van der Meer J.W. Substitution therapy in immunodeficient patients with anti-IgA antibodies or severe adverse reactions to previous immunoglobulin therapy.Neth J Med. 2003; 61: 213-217PubMed Google Scholar, 20Salama A. Schwind P. Schonhage K. Genth R. Cotting C. Hustinx H. et al.Rapid detection of antibodies to immunoglobulin A molecules by using the particle gel immunoassay.Vox Sang. 2001; 81: 45-48Crossref PubMed Scopus (30) Google Scholar, 24Bjorkander J. Hammarstrom L. Smith C.I. Buckley R.H. Cunningham-Rundles C. Hanson L.A. Immunoglobulin prophylaxis in patients with antibody deficiency syndromes and anti-IgA antibodies.J Clin Immunol. 1987; 7: 8-15Crossref PubMed Scopus (89) Google Scholar, 25Ferreira A. Garcia Rodriguez M.C. Lopez-Trascasa M. Pascual Salcedo D. Fontan G. Anti-IgA antibodies in selective IgA deficiency and in primary immunodeficient patients treated with gamma-globulin.Clin Immunol Immunopathol. 1988; 47: 199-207Crossref PubMed Scopus (51) Google Scholar, 26Hedderich U. Kratzsch G. Stephen W. Dichtelmuller H. Olischlager K. Heimpel H. Immunoglobulin substitution therapy in a patient with primary hypogammaglobulinaemia and anti-IgA antibodies.Clin Allergy. 1986; 16: 339-344Crossref PubMed Scopus (11) Google Scholar, 27Frankel S.J. Polmar S.H. Grumet F.C. Wedner H.J. Anti-IgA antibody associated reactions to intravenous gammaglobulin in a patient who tolerated intramuscular gammaglobulin.Ann Allergy. 1986; 56: 436-439PubMed Google Scholar, 28Cunningham-Rundles C. Zhou Z. Mankarious S. Courter S. Long-term use of IgA-depleted intravenous immunoglobulin in immunodeficient subjects with anti-IgA antibodies.J Clin Immunol. 1993; 13: 272-278Crossref PubMed Scopus (82) Google Scholar, 29Rachid R. Castells M. Cunningham-Rundles C. Bonilla F.A. Association of anti-IgA antibodies with adverse reactions to γ-globulin infusion.J Allergy Clin Immunol. 2011; 128 (e1): 228-230Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 30Ahrens N. Hoflich C. Bombard S. Lochs H. Kiesewetter H. Salama A. Immune tolerance induction in patients with IgA anaphylactoid reactions following long-term intravenous IgG treatment.Clin Exp Immunol. 2008; 151: 455-458Crossref PubMed Scopus (17) Google Scholar, 31Salama A. Temmesfeld B. Hippenstiel S. Kalus U. Suttorp N. Kiesewetter H. A new strategy for the prevention of IgA anaphylactic transfusion reactions.Transfusion. 2004; 44: 509-511Crossref PubMed Scopus (20) Google Scholar, 32Ropars C. Caldera L.H. Griscelli C. Homberg J.C. Salmon C. Anti-immunoglobulin antibodies in immunodeficiencies: their influence on intolerance reactions to gamma-globulin administration.Vox Sang. 1974; 27: 294-301Crossref PubMed Scopus (9) Google Scholar, 33Seligmann M. Aucouturier P. Danon F. Preud'Homme J.L. Changes in serum immunoglobulin patterns in adults with common variable immunodeficiency.Clin Exp Immunol. 1991; 84: 23-27Crossref PubMed Scopus (28) Google Scholar Some of these reports lacked information about the type of anti-IgA antibodies (class or subclass specific), patient diagnosis, or total IgA level.Table ICharacteristics of IgA-deficient patients with IgG anti-IgA antibodies reacting to gamma globulin productsPatient no.Age (y)SexDiagnosisIgA (mg/dL)IgG anti-IgA titerMethodSpecificityReactionProduct causing reaction/IgA content∗Expressed as micrograms per milliliter.Product tolerated/IgA content∗Expressed as micrograms per milliliter.Reference1UKMCVID<51:262,144PHAUKANAIVIG/<2024Bjorkander J. Hammarstrom L. Smith C.I. Buckley R.H. Cunningham-Rundles C. Hanson L.A. Immunoglobulin prophylaxis in patients with antibody deficiency syndromes and anti-IgA antibodies.J Clin Immunol. 1987; 7: 8-15Crossref PubMed Scopus (89) Google Scholar244FCVID<11:32,718ELISAClassMODIVIG/720IVIG/2010Cunningham-Rundles C. Wong S. Bjorkander J. Hanson L.A. Use of an IgA-depleted intravenous immunoglobulin in a patient with an anti-IgA antibody.Clin Immunol Immunopathol. 1986; 38: 141-149Crossref PubMed Scopus (16) Google Scholar322FCVID1.21:12,800†Patient with IgE anti-IgA.ELISAClassANAIVIG25Ferreira A. Garcia Rodriguez M.C. Lopez-Trascasa M. Pascual Salcedo D. Fontan G. Anti-IgA antibodies in selective IgA deficiency and in primary immunodeficient patients treated with gamma-globulin.Clin Immunol Immunopathol. 1988; 47: 199-207Crossref PubMed Scopus (51) Google Scholar441MCVID01:2,560-10,240PHAClassANAIVIG/500IVIG/3-2326Hedderich U. Kratzsch G. Stephen W. Dichtelmuller H. Olischlager K. Heimpel H. Immunoglobulin substitution therapy in a patient with primary hypogammaglobulinaemia and anti-IgA antibodies.Clin Allergy. 1986; 16: 339-344Crossref PubMed Scopus (11) Google Scholar515MCVID01:8,000†Patient with IgE anti-IgA.PHAUKANAIVIG/15IVIG/1.611Burks A.W. Sampson H.A. Buckley R.H. Anaphylactic reactions after gamma globulin administration in patients with hypogammaglobulinemia. Detection of IgE antibodies to IgA.N Engl J Med. 1986; 314: 560-564Crossref PubMed Scopus (314) Google Scholar628MCVID<0.091:6,400ELISAUKANAIVIG (<100)IVIG/160‡Premedicated with steroids and antihistamine.12Horn J. Thon V. Bartonkova D. Salzer U. Warnatz K. Schlesier M. et al.Anti-IgA antibodies in common variable immunodeficiency (CVID): diagnostic workup and therapeutic strategy.Clin Immunol. 2007; 122: 156-162Crossref PubMed Scopus (68) Google Scholar733FCVID<0.091:6,400ELISAUKANAIVIG/<100SCIG12Horn J. Thon V. Bartonkova D. Salzer U. Warnatz K. Schlesier M. et al.Anti-IgA antibodies in common variable immunodeficiency (CVID): diagnostic workup and therapeutic strategy.Clin Immunol. 2007; 122: 156-162Crossref PubMed Scopus (68) Google Scholar833FCVID<0.091:1,600ELISAUKANAIVIG/2,500SCIG12Horn J. Thon V. Bartonkova D. Salzer U. Warnatz K. Schlesier M. et al.Anti-IgA antibodies in common variable immunodeficiency (CVID): diagnostic workup and therapeutic strategy.Clin Immunol. 2007; 122: 156-162Crossref PubMed Scopus (68) Google Scholar945FCVID<101:1,000PHAClassANAIVIG/27027Frankel S.J. Polmar S.H. Grumet F.C. Wedner H.J. Anti-IgA antibody associated reactions to intravenous gammaglobulin in a patient who tolerated intramuscular gammaglobulin.Ann Allergy. 1986; 56: 436-439PubMed Google Scholar1039MIGG2D<11:500ELISAClassANAIVIG/270IVIG (0.4-2.9)28Cunningham-Rundles C. Zhou Z. Mankarious S. Courter S. Long-term use of IgA-depleted intravenous immunoglobulin in immunodeficient subjects with anti-IgA antibodies.J Clin Immunol. 1993; 13: 272-278Crossref PubMed Scopus (82) Google Scholar1149FCVID71:500ELISAClassMODIVIG/720IVIG (0.4-2.9)28Cunningham-Rundles C. Zhou Z. Mankarious S. Courter S. Long-term use of IgA-depleted intravenous immunoglobulin in immunodeficient subjects with anti-IgA antibodies.J Clin Immunol. 1993; 13: 272-278Crossref PubMed Scopus (82) Google Scholar1249FCVID<0.091:400ELISAUKANAIVIG <100SCIG12Horn J. Thon V. Bartonkova D. Salzer U. Warnatz K. Schlesier M. et al.Anti-IgA antibodies in common variable immunodeficiency (CVID): diagnostic workup and therapeutic strategy.Clin Immunol. 2007; 122: 156-162Crossref PubMed Scopus (68) Google Scholar1336FCVID<0.091:400ELISAUKMODIVIG/(50-6,000)SCIG12Horn J. Thon V. Bartonkova D. Salzer U. Warnatz K. Schlesier M. et al.Anti-IgA antibodies in common variable immunodeficiency (CVID): diagnostic workup and therapeutic strategy.Clin Immunol. 2007; 122: 156-162Crossref PubMed Scopus (68) Google Scholar1430FSIGAD<0.051:256PGIUKANARhoGAM20Salama A. Schwind P. Schonhage K. Genth R. Cotting C. Hustinx H. et al.Rapid detection of antibodies to immunoglobulin A molecules by using the particle gel immunoassay.Vox Sang. 2001; 81: 45-48Crossref PubMed Scopus (30) Google Scholar1520FCVID<11:200ELISAClassANAIVIG/270-720IVIG (0.4-2.9)28Cunningham-Rundles C. Zhou Z. Mankarious S. Courter S. Long-term use of IgA-depleted intravenous immunoglobulin in immunodeficient subjects with anti-IgA antibodies.J Clin Immunol. 1993; 13: 272-278Crossref PubMed Scopus (82) Google Scholar1652FCVID<5-101:64PGIUKANAIVIGIVIG (50-2,500)§IVIG was well tolerated when anti-IgA titer was no more detectable.30Ahrens N. Hoflich C. Bombard S. Lochs H. Kiesewetter H. Salama A. Immune tolerance induction in patients with IgA anaphylactoid reactions following long-term intravenous IgG treatment.Clin Exp Immunol. 2008; 151: 455-458Crossref PubMed Scopus (17) Google Scholar1740MCVID<6.71:32PGIUKANAIVIG/100IVIG (100-2,500)¶IVIG with increased IgA content was well tolerated when anti-IgA titer was no more detectable.30Ahrens N. Hoflich C. Bombard S. Lochs H. Kiesewetter H. Salama A. Immune tolerance induction in patients with IgA anaphylactoid reactions following long-term intravenous IgG treatment.Clin Exp Immunol. 2008; 151: 455-458Crossref PubMed Scopus (17) Google Scholar, 31Salama A. Temmesfeld B. Hippenstiel S. Kalus U. Suttorp N. Kiesewetter H. A new strategy for the prevention of IgA anaphylactic transfusion reactions.Transfusion. 2004; 44: 509-511Crossref PubMed Scopus (20) Google Scholar1833FCVID<51:4PGIUKANAIVIG/(2,000-2,500)IVIG (<50)30Ahrens N. Hoflich C. Bombard S. Lochs H. Kiesewetter H. Salama A. Immune tolerance induction in patients with IgA anaphylactoid reactions following long-term intravenous IgG treatment.Clin Exp Immunol. 2008; 151: 455-458Crossref PubMed Scopus (17) Google Scholar1962FCVID<51:4PGIUKANAIVIG (15-2,500)IVIG (50-2,500)¶IVIG with increased IgA content was well tolerated when anti-IgA titer was no more detectable.30Ahrens N. Hoflich C. Bombard S. Lochs H. Kiesewetter H. Salama A. Immune tolerance induction in patients with IgA anaphylactoid reactions following long-term intravenous IgG treatment.Clin Exp Immunol. 2008; 151: 455-458Crossref PubMed Scopus (17) Google Scholar2070MCVID<51:2PGIUKANAIVIG (<2,000)IVIG (<50-2,500)¶IVIG with increased IgA content was well tolerated when anti-IgA titer was no more detectable.30Ahrens N. Hoflich C. Bombard S. Lochs H. Kiesewetter H. Salama A. Immune tolerance induction in patients with IgA anaphylactoid reactions following long-term intravenous IgG treatment.Clin Exp Immunol. 2008; 151: 455-458Crossref PubMed Scopus (17) Google Scholar2119FCVID<0.0013.95 μg/mLELISAClassANAIVIG <10SCIG29Rachid R. Castells M. Cunningham-Rundles C. Bonilla F.A. Association of anti-IgA antibodies with adverse reactions to γ-globulin infusion.J Allergy Clin Immunol. 2011; 128 (e1): 228-230Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar2218FSIGAD0YesYes indicates anti-IgA is present, titer not specified.PHAClassANAIMIG8Vyas G.N. Perkins H.A. Fudenberg H.H. Anaphylactoid transfusion reactions associated with anti-IgA.Lancet. 1968; 2: 312-315Abstract PubMed Google Scholar23UKMUKUKYesPHAClassANAIMIG or IVIG32Ropars C. Caldera L.H. Griscelli C. Homberg J.C. Salmon C. Anti-immunoglobulin antibodies in immunodeficiencies: their influence on intolerance reactions to gamma-globulin administration.Vox Sang. 1974; 27: 294-301Crossref PubMed Scopus (9) Google Scholar24UKMCVID<0.1YesPHAUKANAIMIGSCIG13Eijkhout H.W. van den Broek P.J. van der Meer J.W. Substitution therapy in immunodeficient patients with anti-IgA antibodies or severe adverse reactions to previous immunoglobulin therapy.Neth J Med. 2003; 61: 213-217PubMed Google Scholar25UKMCVID<0.1YesPHAUKANAIMIGSCIG13Eijkhout H.W. van den Broek P.J. van der Meer J.W. Substitution therapy in immunodeficient patients with anti-IgA antibodies or severe adverse reactions to previous immunoglobulin therapy.Neth J Med. 2003; 61: 213-217PubMed Google Scholar26UKFCVID<0.1YesPHAUKANAIVIG/1,140SCIG13Eijkhout H.W. van den Broek P.J. van der Meer J.W. Substitution therapy in immunodeficient patients with anti-IgA antibodies or severe adverse reactions to previous immunoglobulin therapy.Neth J Med. 2003; 61: 213-217PubMed Google Scholar2729FCVID<5YesUKUKMODIVIGIVIG33Seligmann M. Aucouturier P. Danon F. Preud'Homme J.L. Changes in serum immunoglobulin patterns in adults with common variable immunodeficiency.Clin Exp Immunol. 1991; 84: 23-27Crossref PubMed Scopus (28) Google ScholarANA, Anaphylaxis; F, female; IMIG, intramuscular immunoglobulin; M, male; MOD, moderate systemic symptoms, including abdominal pain, myalgia, nausea, fever, and rigors; PGI, particle gel immunoassay; UK, unknown.∗ Expressed as micrograms per milliliter.† Patient with IgE anti-IgA.‡ Premedicated with steroids and antihistamine.§ IVIG was well tolerated when anti-IgA titer was no more detectable.¶ IVIG with increased IgA content was well tolerated when anti-IgA titer was no more detectable.|| Yes indicates anti-IgA is present, titer not specified. Open table in a new tab ANA, Anaphylaxis; F, female; IMIG, intramuscular immunoglobulin; M, male; MOD, moderate systemic symptoms, including abdomi
Referência(s)