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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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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. |
format | Online Article Text |
id | pubmed-8514775 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
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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