Селективный иммуноглобулин дефицит
| Селективный иммуноглобулин дефицит | |
|---|---|
 | |
| Димерная молекула IgA. 1 H-Chain, 2 L-Chain, 3 J-Chain, 4 секреторный компонент | |
| Специальность | Иммунология  |
Селективный иммуноглобулин А (IgA) дефицит ( SIGAD [ 1 ] ) является своего рода иммунодефицитом , тип гипогаммаглобулинемии . У людей с этим дефицитом отсутствует иммуноглобулин А (IgA), тип антитела , который защищает от инфекций слизистых оболочек, выстилающих рты, дыхательные пути и пищеварительный тракт. Он определяется как неопределяемый уровень IgA в сыворотке в присутствии нормальных уровней IgG и IgM в сыворотке , у лиц старше 4 лет. Это наиболее распространенный из первичных недостатков антител. Большинство таких людей остаются здоровыми на протяжении всей своей жизни и никогда не диагностируются.
Признаки и симптомы
[ редактировать ]85–90% людей с дефицитом IgA являются бессимптомными, хотя причина отсутствия симптомов относительно неизвестна и по-прежнему остается предметом интереса и противоречия. [ 2 ] Некоторые пациенты с дефицитом IgA имеют тенденцию к развитию рецидивирующих синопульмоночных инфекций, желудочно -кишечных инфекций и расстройств, аллергии, аутоиммунных состояний и злокачественных новообразований. [2] These infections are generally mild and would not usually lead to an in-depth workup except when unusually frequent. They rarely present with severe reactions, including anaphylaxis, to blood transfusions or intravenous immunoglobulin due to the presence of IgA in these blood products. Patients have an increased susceptibility to pneumonia and recurrent episodes of other respiratory infections and a higher risk of developing autoimmune diseases in middle age.[3]
IgA deficiency and common variable immunodeficiency (CVID) feature similar B cell differentiation arrests,[4] but it does not present the same lymphocyte subpopulation abnormalities.[5] IgA-deficient patients may progress to panhypogammaglobulinemia characteristic of CVID.[4] Selective IgA and CVID are found in the same family.[4]
Cause
[edit]Selective IgA deficiency is inherited in less than half of cases,[6] but has been associated with differences in chromosomes 18, 14 and 6. Selective IgA deficiency is often inherited, but fewer than half of all cases but has been associated with some congenital intrauterine infections.[4]
Pathophysiology
[edit]Pathogenesis of IgA Deficiency
‘In IgA-deficient patients, the common finding is a maturation defect in B cells to produce IgA’. ‘In IgA deficiency, B cells express IgA; however, they are of immature phenotype with the coexpression of IgM and IgD, and they cannot fully develop into IgA-secreting plasma cells’. [7]
There is an inherited inability to produce immunoglobulin A (IgA), a part of the body's defenses against infection at the body's surfaces (mainly the surfaces of the respiratory and digestive systems). As a result, bacteria at these locations are somewhat more able to cause disease.[citation needed]
Types include:
| Type | OMIM | Gene | Locus |
|---|---|---|---|
| IGAD1 | 137100 | Unknown; MSH5 suggested[8][9] | 6p21 |
| IGAD2 | 609529 | TNFRSF13B | 17p11 |
Diagnosis
[edit]When suspected, the diagnosis can be confirmed by laboratory measurement of IgA level in the blood. SIgAD is an IgA level < 7 mg/dL with normal IgG and IgM levels (reference range 70–400 mg/dL for adults; children somewhat less).[10]
Treatment
[edit]The treatment consists of identification of co-morbid conditions, preventive measures to reduce the risk of infection, and prompt and effective treatment of infections. Infections in an IgA-deficient person are treated as usual (i.e., with antibiotics). There is no treatment for the underlying disorder.[11] All SIgAD patients, even if asymptomatic, should receive pneumococcal and influenza vaccines, but should avoid live attenuated vaccines.[12]
Use of IVIG as treatment
[edit]There is a historical popularity in using intravenous immunoglobulin (IVIG) to treat SIgAD, but the consensus is that there is no evidence that IVIG treats this condition.[13][14][15] In cases where a patient presents SIgAD and another condition which is treatable with IVIG, then a physician may treat the other condition with IVIG.[14] The use of IVIG to treat SIgAD without first demonstrating an impairment of specific antibody formation is not recommended.[14][16][17][15][13]
Prognosis
[edit]Prognosis is excellent, although there is an association with autoimmune disease. Of note, selective IgA deficiency can complicate the diagnosis of one such condition, celiac disease, as the deficiency masks the high levels of certain IgA antibodies usually seen in celiac disease.[18]
As opposed to the related condition CVID, selective IgA deficiency is not associated with an increased risk of cancer.[19]
Patients with Selective IgA deficiency rarely have severe reactions to blood transfusions.[20] Although Selective IgA deficiency is common,[21][22][23] severe reactions to blood transfusions are very rare.[20][22][24] People with selective IgA deficiency do not require special blood products unless they have a history of a severe allergic reaction to a blood transfusion.[25][26][27]
Epidemiology
[edit]Prevalence varies by population, but is on the order of 1 in 100 to 1 in 1000 people,[21] making it relatively common. SIgAD occurs in 1 in 39 to 1 in 57 people with celiac disease. This is much higher than the prevalence of selective IgA deficiency in the general population.[28] It is also significantly more common in those with type 1 diabetes.[citation needed]
It is more common in males than in females.[29]
See also
[edit]References
[edit]- ^ Hammarström L, Vorechovsky I, Webster D (May 2000). "Selective IgA deficiency (SIgAD) and common variable immunodeficiency (CVID)". Clinical and Experimental Immunology. 120 (2): 225–231. doi:10.1046/j.1365-2249.2000.01131.x. PMC 1905641. PMID 10792368.
- ^ Jump up to: a b Yel, L. (2010) 'Selective IgA Deficiency', Journal of Clinical Immunology, 30(1), pp. 10-16.
- ^ Koskinen S (1996). "Long-term follow-up of health in blood donors with primary selective IgA deficiency". J Clin Immunol. 16 (3): 165–70. doi:10.1007/BF01540915. PMID 8734360. S2CID 28529140.
- ^ Jump up to: a b c d Harrison's Principles of Internal Medicine, 17th edition, pag. 2058
- ^ Litzman J, Vlková M, Pikulová Z, Stikarovská D, Lokaj J (February 2007). "T and B lymphocyte subpopulations and activation/differentiation markers in patients with selective IgA deficiency". Clin. Exp. Immunol. 147 (2): 249–54. doi:10.1111/j.1365-2249.2006.03274.x. PMC 1810464. PMID 17223965.
- ^ Cunningham-Rundles C. (1990). "Genetic Aspects of IgA Deficiency". Adv Hum. Genet. 19: 235–266. doi:10.1007/978-1-4757-9065-8_4. PMID 2193490.
- ^ Yel, L. (2010). "Selective IgA Deficiency". J Clin Immunol. 30 (1): 10–16. doi:10.1007/s10875-009-9357-x. PMC 2821513. PMID 20101521.
- ^ Sekine H, Ferreira RC, Pan-Hammarström Q, et al. (April 2007). "Role for Msh5 in the regulation of Ig class switch recombination". Proc. Natl. Acad. Sci. U.S.A. 104 (17): 7193–8. Bibcode:2007PNAS..104.7193S. doi:10.1073/pnas.0700815104. PMC 1855370. PMID 17409188.
- ^ Online Mendelian Inheritance in Man (OMIM): 137100
- ^ Swain S, Selmi C, Gershwin ME, Teuber SS (December 2019). "The clinical implications of selective IgA deficiency". Journal of Translational Autoimmunity. 2: 100025. doi:10.1016/j.jtauto.2019.100025. ISSN 2589-9090. PMC 7388344. PMID 32743511.
- ^ Vosughimotlagh A, Rasouli SE, Rafiemanesh H, Safarirad M, Sharifinejad N, Madanipour A, Dos Santos Vilela MM, Heropolitańska-Pliszka E, Azizi G (2023-08-28). "Clinical manifestation for immunoglobulin A deficiency: a systematic review and meta-analysis". Allergy, Asthma & Clinical Immunology. 19 (1): 75. doi:10.1186/s13223-023-00826-y. ISSN 1710-1492. PMC 10463351. PMID 37641141.
- ^ Swain S, Selmi C, Gershwin ME, Teuber SS (December 2012). "The clinical implications of selective IgA deficiency". Journal of Translational Autoimmunity. 2: 100025. doi:10.1016/j.jtauto.2019.100025. ISSN 2589-9090. PMC 7388344. PMID 32743511.
- ^ Jump up to: a b American Academy of Allergy, Asthma, and Immunology. "Five Things Physicians and Patients Should Question" (PDF). Choosing Wisely: An Initiative of the ABIM Foundation. American Academy of Allergy, Asthma, and Immunology. Retrieved August 14, 2012.
- ^ Jump up to: a b c Francisco A. Bonilla, I. Leonard Bernstein, David A. Khan, Zuhair K. Ballas, Javier Chinen, Michael M. Frank, Lisa J. Kobrynski, Arnold I. Levinson, Bruce Mazer (May 2005). "Practice parameter for the diagnosis and management of primary immunodeficiency" (PDF). Annals of Allergy, Asthma & Immunology. 94 (5): S1–S63. doi:10.1016/s1081-1206(10)61142-8. PMID 15945566. Archived from the original (PDF) on 11 November 2011. Retrieved 27 August 2012.
- ^ Jump up to: a b Perez EE, Orange JS, Bonilla F, Chinen J, Chinn IK, Dorsey M, El-Gamal Y, Harville TO, Hossny E (2017). "Update on the use of immunoglobulin in human disease: A review of evidence". Journal of Allergy and Clinical Immunology. 139 (3): S1–S46. doi:10.1016/j.jaci.2016.09.023. PMID 28041678.
- ^ Hammarström L, Vorechovsky I, Webster D (2000). "Selective IgA deficiency (SIgAD) and common variable immunodeficiency (CVID)". Clinical and Experimental Immunology. 120 (2): 225–231. doi:10.1046/j.1365-2249.2000.01131.x. PMC 1905641. PMID 10792368.
- ^ Mark Ballow (2008). "85". In Robert R. Rich (ed.). Clinical immunology : principles and practice (3rd ed.). St. Louis, Mo.: Mosby/Elsevier. pp. 1265–1280. ISBN 978-0323044042.
- ^ Принц он, Гари Л. Норман, Уолтер Л. Биндер (ноябрь 2002 г.). «Проверка внутреннего анализа для цитомегаловирусного иммуноглобулина G (CMV IgG) и взаимосвязь авидности с уровнями CMV IgM» . Clin Vaccine Immunol . 9 (6): 1295–1300. doi : 10.1128/cdli.9.4.824-827.2002 . PMC 120015 . PMID 12093680 .
- ^ Mellemkjaer L, Hammarstrom L, Andersen V, et al. (2002). «Риск рака среди пациентов с дефицитом IgA или общим иммунодефицитом переменной и их родственниками: комбинированное датское и шведское исследование» . Клин Эксплуат Иммунол . 130 (3): 495–500. doi : 10.1046/j.1365-2249.2002.02004.x . PMC 1906562 . PMID 12452841 .
- ^ Jump up to: а беременный Vassallo RR (2020). «Обзор: реакции анафилактического переливания IgA. Часть I. Лабораторная диагностика, частота и поставки продуктов с дефицитом IgA» . Иммуногематология . 20 (4): 226–233. doi : 10.21307/иммуногематология-2019-454 . ISSN 0894-203X . PMID 15679454 .
- ^ Jump up to: а беременный «Дефицит IGA: расстройства иммунодефицита: Merck Manual Professional» . Получено 2008-03-01 .
- ^ Jump up to: а беременный Tacquard C, Boudjedir K, Carlier M, Muller JY, Gomis P, Mertes PM (2017). «Реакции переливания гиперчувствительности из -за дефицита IgA редки в соответствии с данными французского гемовиглентности» . Журнал аллергии и клинической иммунологии . 140 (3): 884–885. doi : 10.1016/j.jaci.2017.03.029 . PMID 28414063 .
- ^ Yazdani R, Azizi G, Abolhassani H, Aghamamamadi A (2017). «Селективный дефицит IgA: эпидемиология, патогенез, клинический фенотип, диагностика, прогноз и лечение» . Скандинавский журнал иммунологии . 85 (1): 3–12. doi : 10.1111/sji.12499 . PMID 27763681 .
- ^ «Отчет о выстреле, резюме и дополнение 2017» . Серьезные опасности переливания . Получено 2019-04-26 .
- ^ «5.2 Неинфекционные опасности переливания». Справочник по трансфузионной медицине . Норфолк, Дерек (5 -е изд.). Лондон: канцелярские товары. 2013. ISBN 9780117068469 Полем OCLC 869523772 .
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- ^ «Компоненты с дефицитом IgA» . Transfusion.com.au . Получено 2019-04-26 .
- ^ McGowan KE, Lyon EM, Butzner JD (июль 2008 г.). «Целиаг -болезнь и дефицит IgA: осложнения подходов к серологическим тестированию, возникающие в клинике» . Клиническая химия . 54 (7): 1203–1209. doi : 10.1373/clinchem.2008.103606 . PMID 18487281 .
- ^ Weber-Mzell D, Kotanko P, Hauer AC, et al. (Март 2004 г.). «Пол, возраст и сезонные эффекты на дефицит IgA: исследование 7293 кавказцев». Евро. J. Clin. Инвестировать 34 (3): 224–8. doi : 10.1111/j.1365-2362.2004.01311.x . PMID 15025682 . S2CID 25545688 .