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CVID patients may not respond to influenza immunization

Dear Dr. Saxon, Influenza immunization and common variable immunodeficiency Junker et al. [1] have made an excellent introduction into this exciting series of case discussions with their recommendations about influenza vaccination in common variable immunodeficiency (CVID). Unfortunately, they did not discuss a key problem that faces patients with CVID, namely, that they cannot recognize vaccines sufficiently well to mount a useful immune response on subsequent exposure. This property is now used as part of the ESID and PAGID criteria for CVID [2] . Although particular emphasis is given to poor antibody responses to carbohydrate antigens (measured using pneumococcal antibodies), protein antigen responses are also impaired. Vaccine responses are traditionally examined using antibody levels, but in CVID patients this is a major limitation. Using limiting dilution techniques, the MRC Immunodeficiency Research Group at the Royal Free Hospital in London demonstrated that immunizations with recall antigens (PPD) [3] or neo-antigens (KLH) [4] are significantly impaired in CVID, with extremely low antigen-specific precursor T cell frequencies even after immunization. This may mean that influenza immunization is unlikely to be useful in CVID, since T cell help is unlikely to be forthcoming following immunization, meaning that CVID patients will have to rely on influenza-specific antibodies in their IVIG, anti-viral drugs, and herd immunity by immunization of their household contacts.</P> http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Clinical Immunology Elsevier

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