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Diagnostic Vaccination in Clinical Practice

Testing the antibody response to vaccination (diagnostic vaccination) is crucial in the clinical evaluation of primary immunodeficiency diseases. Guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI) provide detailed recommendations for diagnostic vaccination with pure pne...

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Autores principales: Hansen, Anette Tarp, Söderström, Anna, Jørgensen, Charlotte Sværke, Larsen, Carsten Schade, Petersen, Mikkel Steen, Bernth Jensen, Jens Magnus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8514775/
https://www.ncbi.nlm.nih.gov/pubmed/34659207
http://dx.doi.org/10.3389/fimmu.2021.717873
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author Hansen, Anette Tarp
Söderström, Anna
Jørgensen, Charlotte Sværke
Larsen, Carsten Schade
Petersen, Mikkel Steen
Bernth Jensen, Jens Magnus
author_facet Hansen, Anette Tarp
Söderström, Anna
Jørgensen, Charlotte Sværke
Larsen, Carsten Schade
Petersen, Mikkel Steen
Bernth Jensen, Jens Magnus
author_sort Hansen, Anette Tarp
collection PubMed
description Testing the antibody response to vaccination (diagnostic vaccination) is crucial in the clinical evaluation of primary immunodeficiency diseases. Guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI) provide detailed recommendations for diagnostic vaccination with pure pneumococcal polysaccharide vaccines (PPV). However, the degree of compliance with these guidelines and the utility of the guidelines in actual practice are undescribed. To address this, we systematically evaluated diagnostic vaccination in adult patients with suspected primary immunodeficiency diseases in a single tertiary center from 2011 to 2016 (n = 229). We found that full compliance with the AAAAI guidelines was achieved for only 39 patients (17%), suggesting that the guidelines are not easy to follow. Worse, interpretation according to the guidelines was heavily influenced by which serotype-specific antibodies that were used for the evaluation. We found that the arbitrary choices of serotype-specific antibodies could change the fraction of patients deemed to have ‘adequate immunity’ by a factor of four, exposing an inherent flaw in the guidelines. The flaw relates to dichotomous principles for data interpretation under the AAAAI guidelines. We therefore propose a revised protocol for diagnostic vaccination limited to PPV vaccination, subsequent antibody measurements, and data interpretation using Z-scores. The Z-score compiles multiple individual antibody levels, adjusted for different weighting, into one single continuous variable for each patient. In contrast to interpretation according to the AAAAI guidelines, the Z-scores were robust to variations in the choice of serotype-specific antibodies used for interpretation. Moreover, Z-scores revealed reduced immunity after vaccination in the patients with recurrent pneumonia (a typical symptom of antibody deficiency) compared with control patients. Assessment according to the AAAAI guidelines failed to detect this difference. We conclude that our simplified protocol and interpretation with Z-scores provides more robust clinical results and may enhance the value of diagnostic vaccination.
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spelling pubmed-85147752021-10-15 Diagnostic Vaccination in Clinical Practice Hansen, Anette Tarp Söderström, Anna Jørgensen, Charlotte Sværke Larsen, Carsten Schade Petersen, Mikkel Steen Bernth Jensen, Jens Magnus Front Immunol Immunology Testing the antibody response to vaccination (diagnostic vaccination) is crucial in the clinical evaluation of primary immunodeficiency diseases. Guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI) provide detailed recommendations for diagnostic vaccination with pure pneumococcal polysaccharide vaccines (PPV). However, the degree of compliance with these guidelines and the utility of the guidelines in actual practice are undescribed. To address this, we systematically evaluated diagnostic vaccination in adult patients with suspected primary immunodeficiency diseases in a single tertiary center from 2011 to 2016 (n = 229). We found that full compliance with the AAAAI guidelines was achieved for only 39 patients (17%), suggesting that the guidelines are not easy to follow. Worse, interpretation according to the guidelines was heavily influenced by which serotype-specific antibodies that were used for the evaluation. We found that the arbitrary choices of serotype-specific antibodies could change the fraction of patients deemed to have ‘adequate immunity’ by a factor of four, exposing an inherent flaw in the guidelines. The flaw relates to dichotomous principles for data interpretation under the AAAAI guidelines. We therefore propose a revised protocol for diagnostic vaccination limited to PPV vaccination, subsequent antibody measurements, and data interpretation using Z-scores. The Z-score compiles multiple individual antibody levels, adjusted for different weighting, into one single continuous variable for each patient. In contrast to interpretation according to the AAAAI guidelines, the Z-scores were robust to variations in the choice of serotype-specific antibodies used for interpretation. Moreover, Z-scores revealed reduced immunity after vaccination in the patients with recurrent pneumonia (a typical symptom of antibody deficiency) compared with control patients. Assessment according to the AAAAI guidelines failed to detect this difference. We conclude that our simplified protocol and interpretation with Z-scores provides more robust clinical results and may enhance the value of diagnostic vaccination. Frontiers Media S.A. 2021-09-30 /pmc/articles/PMC8514775/ /pubmed/34659207 http://dx.doi.org/10.3389/fimmu.2021.717873 Text en Copyright © 2021 Hansen, Söderström, Jørgensen, Larsen, Petersen and Bernth Jensen https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Hansen, Anette Tarp
Söderström, Anna
Jørgensen, Charlotte Sværke
Larsen, Carsten Schade
Petersen, Mikkel Steen
Bernth Jensen, Jens Magnus
Diagnostic Vaccination in Clinical Practice
title Diagnostic Vaccination in Clinical Practice
title_full Diagnostic Vaccination in Clinical Practice
title_fullStr Diagnostic Vaccination in Clinical Practice
title_full_unstemmed Diagnostic Vaccination in Clinical Practice
title_short Diagnostic Vaccination in Clinical Practice
title_sort diagnostic vaccination in clinical practice
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8514775/
https://www.ncbi.nlm.nih.gov/pubmed/34659207
http://dx.doi.org/10.3389/fimmu.2021.717873
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