Allergy in Patients with Selective IgA Deficiency

Document Type : Original Article

Authors

Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran

10.22034/igj.2020.224572.1035

Abstract

Introduction: Selective immunoglobulin a deficiency (IgAD) is the most frequent of the primary antibody deficiencies. Patients with IgAD can be either symptomatic or asymptomatic. Symptomatic patients suffer from a wide range of manifestations including allergy, malignancy, and autoimmunity. The prevalence of allergic diseases is assumed to be increased in IgAD patients. In this study, we aimed to evaluate the frequency of allergic disorders in IgAD patients as well as a comparison between these patients and IgA deficient patients without allergy.
Methods: The present cohort study included 166 IgAD patients who were diagnosed at the Research Center for immunodeficiencies in children's medical Center. To compare clinical data and laboratory records, all IgAD patients were classified into two groups as follows: patients with allergic diseases and patients without allergic diseases.
Results: Among 166 patients with IgA deficiency, allergy was seen in 33 patients (19.8%). In this study, respiratory tract infections were the most common clinical presentation in all patients (47.6%). Among the infectious manifestations, pneumonia and sinusitis were significantly higher in patients with allergy compared with patients without allergy (respectively 48.5% vs 26.3%; p = 0.013, 48.5% vs 20.3%; p = 0.001). Based on the laboratory data, the number of platelet and B cells (CD20+) were significantly higher in patients with allergy in comparison to patients without allergy (respectively, p = 0.025, p = 0.44)
Conclusion: The relation between IgAD disease and allergy could lead to severe clinical complications. Thus, these allergy disorders should be considered as an important feature for suitable management and enhancing the life quality in patients with IgAD.

Keywords


1. Yazdani R, Latif A, Tabassomi F, Abolhassani H, Azizi G, Rezaei N, et al. Clinical phenotype classification for selective immunoglobulin A deficiency. Expert Rev Clin Immunol. 2015;11(11):1245-54. 2. Erkocoglu M, Metin A, Kaya A, Ozcan C, Akan A, Civelek E, et al. Allergic and autoimmune disorders in families with selective IgA deficiency. Turk J Med Sci. 2017;47(2):592-8. 3. Aghamohammadi A, Cheraghi T, Gharagozlou M, Movahedi M, Rezaei N, Yeganeh M, et al. IgA deficiency: correlation between clinical and immunological phenotypes. J clin immunol. 2009;29(1):130-6. 4. pashangzadeh S, sohani M. Prevalent Autoimmunities in Patients with Selective IgA Deficiency. Immunology and Genetics Journal, 2019; 2(3): 135-146 5. Yel L. Selective IgA deficiency. J clin immunol. 2010;30(1):10-6. 6. Abolhassani H, Gharib B, Shahinpour S, Masoom S, Havaei A, Mirminachi B, et al. Autoimmunity in patients with selective IgA deficiency. J Investig Allergol Clin Immunol. 2015;25(2):112-9. 7. Yazdani R, Azizi G, Abolhassani H, Aghamohammadi A. Selective IgA Deficiency: Epidemiology, Pathogenesis, Clinical Phenotype, Diagnosis, Prognosis and Management. Scand J Immunol. 2017;85(1):3-12. 8.Cunningham-Rundles C. Physiology of IgA and IgA deficiency. J clin immunol. 2001;21(5):303-9. 9. Rezaei N, Abolhassani H, Kasraian A, Mohammadinejad P, Sadeghi B, Aghamohammadi A. Family study of pediatric patients with primary antibody deficiencies. Iran J Allergy Asthma Immunol. 2013:377-82. 10. Aghamohammadi A, Cheraghi T, Gharagozlou M, Movahedi M, Rezaei N, Yeganeh M, et al. IgA deficiency: correlation between clinical and immunological phenotypes. J clin immunol. 2009;29(1):130-6. 11. Ryan MW, editor AAOA allergy primer: immunodeficiency. International forum of allergy & rhinology; 2014: Wiley Online Library. 12. Yazdani R, Latif A, Tabassomi F, Abolhassani H, Azizi G, Rezaei N, et al. Clinical phenotype classification for selective immunoglobulin A deficiency. Expert Rev Clin Immunol. 2015;11(11):1245-54. 13. Shkalim V, Monselize Y, Segal N, Zan-Bar I, Hoffer V, Garty BZ. Selective IgA deficiency in children in Israel. J clin immunol. 2010;30(5):761-5. 14. Santaella ML, Peredo R, Disdier OM. IgA deficiency: clinical correlates with IgG subclass and mannan-binding lectin deficiencies. P R Health Sci J. 2005;24(2):107-110 15. Dominguez O, Giner M, Alsina L, Martin M, Lozano J, Plaza A, editors. Clinical phenotypes associated with selective IgA deficiency: a review of 330 cases and a proposed follow-up protocol. An Pediatr (Barc). 2012;76(5):261-7. 16. Erkoço─člu M, Metin A, Kaya A, Özcan C, Akan A, Civelek E, et al. Allergic and autoimmune disorders in families with selective IgA deficiency. Turk J Med Sci. 2017;47(2):592-8. 17. Jackson DJ, Gangnon RE, Evans MD, Roberg KA, Anderson EL, Pappas TE, et al. Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children. Am J Respir Crit Care Med. 2008;178(7):667-72. 18. Aytekin C, Tuygun N, Gokce S, Dogu F, Ikinciogullari A. Selective IgA deficiency: clinical and laboratory features of 118 children in Turkey. J clin immunol. 2012;32(5):961-6. 19. Latiff A, Kerr M. The clinical significance of immunoglobulin A deficiency. Ann Clin Biochem. 2007;44(2):131-9. 20. Wang Z, Yunis D, Irigoyen M, Kitchens B, Bottaro A, Alt FW, et al. Discordance between IgA switching at the DNA level and IgA expression at the mRNA level in IgA-deficient patients. Clin immunol. 1999;91(3):263- 70. 21. Ammann AJ, HONG R. Selective IgA deficiency: presentation of 30 cases and a review of the literature. Medicine. 1971;50(3):223. 22. Taylor B, Fergusson D, Mahoney G, Hartley W, Abbott J. Specific IgA and IgE in childhood asthma, eczema and food allergy. Clin Exp Allergy. 1982;12(5):499-505. 23. Buckley RH. Clinical and immunologic features of selective IgA deficiency. Birth Defects Orig. Artic. Ser. 1975;11(1):134-42. 24. Edwards E, Razvi S, Cunningham-Rundles C. IgA deficiency: clinical correlates and responses to pneumococcal vaccine. J Clin immunol. 2004;111(1):93-7. 25. Aghamohammadi A, Abolhassani H, Biglari M, Abolmaali S, Moazzami K, Tabatabaeiyan M, et al. Analysis of switched memory B cells in patients with IgA deficiency. Int Arch Allergy Immunol. 2011;156(4):462-8. 26. Kanok J, Steinberg P, Cassidy J, Petty R, Bayne N. Serum IgE levels in patients with selective IgA deficiency. Ann allergy. 1978;41(4):22-3. 27. Brenninkmeijer E, Schram M, Leeflang M, Bos J, Spuls PI. Diagnostic criteria for atopic dermatitis: a systematic review. Br. J. Dermatol. 2008;158(4):754-65. 28. Wei C-H, Lin M, Hsieh R-K, Tzeng C-H, Liu J-H, Fan S, et al. Selective IgA deficiency and anaphylactoid transfusion reaction: a case report. Zhonghua yi xue za zhi (Taipei). 1996;57(2):165-8. 29. Kumar N, Sharma S, Sethi S, Singh R. Anaphylactoid transfusion reaction with anti-IgA antibodies in an IgA deficient patient: a case reportIndian J Pathol Microbiol.1993;36(3):282-4. 30. Koopman LP, Smit HA, Heijnen M-LA, Wijga A, van Strien RT, Kerkhof M, et al. Respiratory infections in infants: interaction of parental allergy, child care, and siblings—the PIAMA study. Pediatrics. 2001;108(4):943-8.