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Use & Interpretation of Laboratory Tests Books
Use & Interpretation of Laboratory Tests Books

Humoral Immunity Evaluation
Noori Barka, Ph.D.

Chronic and recurrent infections are associated with a variety of immunodeficiencies characterized by impaired IgG antibody production, such as hypogammaglobulinemia, IgG-subclass deficiencies and selective defects in antibody response to polysaccharide or protein antigen.1-3

Deficiencies in concentrations of IgG-subclasses (particularly IgG2 and IgG4) are associated with recurrent infections with polysaccharide-encapsulated organisms.4,5 Total serum IgG concentrations are sometimes misleading because serum IgG can be normal in patients with recurrent infections who are IgG2 deficient, but in whom IgG1 and/or IgG3 are elevated.6 Concentrations of IgG4 measured by radial immunodiffusion are unreliable.7 IgG subclass totals by immunoradiometric assay (IgG1 + IgG2 + IgG3 + IgG4) are much closer to total IgG concentrations determined by rate nephelometry than are the subclass totals by EIA.8

Quantitative measurement of IgG antibody response after adequate challenge with polysaccharide (Streptococcus pneumoniae, Haemophilus influenzae type b and Neisseria meningitidis) or protein (tetanus toxoid, diphtheria toxoid) antigens is considered the ideal approach for the evaluation of humoral immunity in patients with recurrent infections.9-11

EIA for detection of antibodies to polysaccharide antigens of S. pneumoniae types 1, 3, 4, 6B, 7F, 9N, 12F, 14, 18C, 19F or 23F is widely used for the evaluation of humoral immunity.12-14 A normal responder can show a fourfold increase in antibody level of pre- and post-vaccination sera for eight or more of the 12 serotypes. Results for patients with elevated pre-vaccination levels should be interpreted with caution because they might be normal responders, but still not show a fourfold increase in antibody titer. Patients who are considered normal responders but still suffer recurrent infections can have low affinity antibodies. Measurement of antibody avidity and functional capacity are recommended in evaluation of humoral immunity.15-17

Evaluation of the immune response to protein antigens can be used to determine the patient's ability to mount an active immune response after treatment with high doses of immunosupressives.18
See Also:
Clostridium tetani
Corynebacterium diphtheriae
Haemophilus influenzae b
Streptococcus pneumoniae


Relevant Tests Offered by Specialty
1146P Humoral Immune Evaluation (Pneumo 14) + H. Flu B Pre/ Post
1049 Humoral Immune Evaluation (Pneumo 23)
1088P Humoral Immune Evaluation (Pneumo 23) + H. Flu B Pre/Post
1088 Humoral Immune Evaluation (Pneumo 23) + H. influenzae Type B
1047 Humoral Immune Evaluation (Pneumo 7)
1087P Humoral Immune Evaluation (Pneumo 7) + H. Flu B Pre/Post
1087 Humoral Immune Evaluation (Pneumo 7) + H. Influenzae B
1047P Humoral Immune Evaluation (Pneumo 7) Pre/Post
1049P Humoral Immune Evaluation, (Pneumo 23) Pre/Post
1149 Humoral Immune Status Survey (Pneumo 23)
1149P Humoral Immune Status Survey (Pneumo 23) Pre/Post
1506 IgA, Serum
1623 IgG Subclass 1, 2, 3, & 4
1505 IgG, Serum
1508 IgM, Serum
Tests are subject to change. For additional information on these tests or to place an order, please call Specialty's Client Services at 800-421-4449.

REFERENCES

  1. Shapiro GG, Virant FS, Furukawa CT, Pierson WE, Bierman CW. Immunologic defects in patients with refractory sinusitis. Pediatrics 1991;87:311-6.
  2. Epstein MM, Gruskay F. Selective deficiency in pneumococcal antibody response in children with recurrent infections. Ann Allergy Asthma Immunol 1995;75:125-31.
  3. French MA, Denis KA, Dawkins R, Peter JB. Severity of infections in IgA deficiency: correlation with decreased serum antibodies to pneumococcal polysaccharides and decreased serum IgG2 and/or IgG4. Clin Exp Immunol 1995;100:47-53.
  4. Beard LJ, Hagedorn JF, Ferrante A. Low IgG4 concentrations in infants with Haemophilus influenzae type b infections. Pediatr Allergy Immunol 1993;4:1-5.
  5. Hamilos DL, Young RM, Peter JB, Agopian MS, Iklé DN, Barka N. Hypogamma-globulinemia in asthmatic patients. Ann Allergy 1992;68:472-80.
  6. French MAH, Harrison G. Serum IgG subclasses in patients with an increased susceptibility to respiratory tract infections. Aust N Z J Med 1987;17:402-6.
  7. Ochs HD, Wedgewood RJ. IgG subclass deficiencies. Annu Rev Med 1987;38:325-40.
  8. Agopian M, Peter JB. Comparison of IRMA and EIA in determining IgG subclasses. Unpublished observations, 1990.
  9. Wheeler JG, Steiner D. Evaluation of humoral responsiveness in children. Pediatr Infect Dis J 1992;11:304-10.
  10. Ambrosino DM, Siber GR, Chilmonczyk BA, Jernberg JB, Fiberg RW. An immunodeficiency characterized by impaired antibody responses to polysaccharides. N Engl J Med 1987;316:790-3.
  11. Madore DV, Anderson P, Baxter BD, et al. Interlaboratory study evaluating quantitations of antibodies to Haemophilus influenzae type b polysaccharide by enzyme-linked immunosorbant assay ELISA. Clin Diagn Lab Immunol 1996;3:84-8.
  12. Bocter FN, Barka NE, Agopian MS. Quantitation of IgG antibody to Streptococcus pneumoniae vaccine by ELISA and FAST-ELISA using tyraminated antigen. J Immunol Methods 1989;120:167-71.
  13. Avanzini MA, Carra AM, Maccario R, et al. Antibody response to pneumococcal vaccine in children receiving bone marrow transplantation. J Cliln Immunol 1995;15:137-44.
  14. Sankilampi U, Honkanen PO, Blogigu A, Herva E, Leinonen M. Antibody response to pneumococcal capsular polysaccharide vaccine in the elderly. J Infect Dis 1996;173:387-93.
  15. Ojo-Amaize EA, Church JA, Barka NE, Agopian MS, Peter JB. A rapid and sensitive chemiluminescence assay for evaluation of functional opsonic activity of Haemophilus influenzae type b specific antibodies. Clin Diagn Lab Immunol 1995;2:286-90.
  16. Granoff DM, Lucas AH. Laboratory correlates of protection against Haemophilus influenzae type b disease: importance of assessment of antibody avidity and immunologic memory. Ann N Y Acad Sci 1995;754:278-88.
  17. Konradsen HB. Quantity and avidity of pneumococcal antibodies before and up to five years after pneumococcal vaccination of elderly persons. Clin Infect Dis 1995;21:616-20.
  18. Virella G, Hyman B. Quantitation of anti-tetanus and anti-diphtheria antibodies by enzyme immunoassay: methodology and applications. J Clin Lab Analysis 1991;5:43.





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