The relative frequency of primary immunodeficiency diseases in pediatric patients with recurrent sinusitis and otitis media
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Assistant professor of Pediatric Department, Abuzar Children’s Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Associated Professor of otolaryngology Department, Hearing research center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Publication date: 2018-12-28
Electron J Gen Med 2019;16(1):em102
Background & Purpose:
Recurrent and chronic infections of the ear, throat and nose are one of the most important health problems worldwide, and they clearly affect the quality of life in adults and children. In spite of proper diagnosis and proper treatment, groups of these patients do not respond to routine treatment and are still being symptomatic and have chronic complications in these patients. Various studies have shown that the immune system is defective in some patients with frequent and chronic infections of the ear, throat and nose. Therefore, the present study was conducted to evaluate the relative frequency of primary immunodeficiency diseases in children with sinusitis and recurrent middle ear infections.

Methods & Materials:
This study evaluated underlying immune defects in patients with otitis media or recurrent sinusitis. Serum levels of IgA, IgG and IgM were evaluated by nephlometric test. In addition, a complete count of blood cells was also evaluated. The rate of humoral response to diphtheria and tetanus was also assessed. NBT was used to evaluate the immune system.

Out of 62 patients, 12 patients (19%) had defects in at least one antibody class. Five patients with IgA deficiency (which 2 of them have also showed IgG concurrent deficiency) were seen. Also, 4 patients had IgG deficiency and 3 patients showed IgM deficiency. None of the patients had abnormal cell count. NBT response was also normal in all patients.

In general, the findings of the present study in line with previous studies showed that a large proportion of children with recurrent otitis media and sinusitis have abnormal immunologic function. Therefore, it is recommended that the evaluation of immune deficiency be considered in these patients.

Amirzargar A, Feghhi S, Nicknam MH, Saki N. Immunological aspects of secretory otitis media in Iranian children, immunoglobulin and complement concentration in serum and glue. Iran J Allergy Asthma Immunol. 2003 Mar;2(1):25-30. PMid:17301353.
Benninger MS, Ferguson BJ, Hadley JA, et al. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg. 2003;129:1–32. https://doi.org/10.1016/S0194-....
Pichichero ME, Casey JR. Otitis media. Expert Opin Pharmacother 2002;3:1073-90. https://doi.org/10.1517/146565... PMid:12150687.
Buckley RH. Pulmonary complications of primary immunodeficiencies. Paediatr Respir Rev.2004;5:225–33. https://doi.org/10.1016/S1526-....
Saki N, Nikakhlagh S, Ahmadi KH. Comparison of PCR Assay and Culture for Detecting Bacteria in Middle Ear Fluid of Children with Otitis Media with Effusion. Int Advance Otolryngol. 2009;5(1):31.
Ramsey B, Richardson MA. Impact of sinusitis in cystic fibrosis. J Allergy Clin Immunol.1992;90:547–52. https://doi.org/10.1016/0091-6....
Rayner CF, Rutman A, Dewar A, et al. Ciliary disorientation in patients with chronic upper respiratory tract inflammation. Am J Respir Crit Care Med. 1995;151:800–4. https://doi.org/10.1164/ajrccm... PMid:7881674.
Umetsu DT, Ambrosino DM, Quinti I, et al. Recurrent sinopulmonary infection and impaired antibody response to bacterial capsular polysaccharide antigen in children with selective IgG-subclass deficiency. N Engl J Med 1985;313:1247-51. https://doi.org/10.1056/NEJM19... PMid:3877240.
Luzi G, Businco L, Aiuti F. Primary immunodeficiency syndromes in Italy: a report of the national register in children and adults. J Clin Immunol. 1983;3:316–20. https://doi.org/10.1007/BF0091... PMid:6655036.
Matamoros Flori N, Mila Llambi J, Espanol Boren T, et al. Primary immunodeficiency syndrome in Spain: first report of the National Registry in Children and Adults. J Clin Immunol. 1997;17:333–9. https://doi.org/10.1023/A:1027... PMid:9258772.
Aghamohammadi A, Moein M, Farhoudi A, et al. Primary immunodeficiency in Iran: first report of the National Registry of PID in Children and Adults. J Clin Immunol. 2002;22:375–80. https://doi.org/10.1023/A:1020... PMid:12462337.
Leiva LE, Zelazco M, Oleastro M, et al. Primary immunodeficiency diseases in Latin America: the second report of the LAGID registry. J Clin Immunol. 2007;27:101–8. https://doi.org/10.1007/s10875... PMid:17191150.
Bonilla FA, Bernstein IL, Khan DA, et al. Practice parameter for the diagnosis and management of primary immunodeficiency. Ann Allergy Asthma Immunol. 2005;94:1–63. https://doi.org/10.1016/S1081-....
Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol. 1999;92:34–48. https://doi.org/10.1006/clim.1... PMid:10413651.
Hermaszewski RA, Webster AD. Primary hypogammaglobulinaemia: a survey of clinical manifestations and complications. Q J Med. 1993;86:31–42. PMid:8438047.
Aghamohammadi A, Farhoudi A, Moin M, et al. Clinical and immunological features of 65 Iranian patients with common variable immunodeficiency. Clin Diagn Lab Immunol. 2005;12:825–832. https://doi.org/10.1128/CDLI.1....
Galicia G, Betancourt MA, Canales LE, et al. Ear, nose, and throat manifestations in patients with primary immunodeficiencies. Rev Alerg Mex. 1999;46:108–19. PMid:10488654.
Seymour B, Miles J, Haeney M. Primary antibody deficiency and diagnostic delay. J Clin Pathol. 2005;58:546–7. https://doi.org/10.1136/jcp.20... PMid:15858130 PMCid:PMC1770645.
Tahkokallio O, Seppala IJ, Sarvas H, et al. Concentrations of serum immunoglobulins and antibodies to pneumococcal capsular polysaccharides in patients with recurrent or chronic sinusitis. Ann Otol Rhinol Laryngol 2001;110(7 Pt 1):675-81. https://doi.org/10.1177/000348... PMid:11465828.
Shapiro GG, Virant FS, Furukawa CT, et al. Immunologic defects in patients with refractory sinusitis. Pediatrics 1991;87:311-6. PMid:2000270.
Finocchi A, Angelini F, Chini L, et al. Evaluation of the relevance of humoral immunodeficiencies in a pediatric population affected by recurrent infections. Pediatr Allergy Immunol 2002;13:443-7. https://doi.org/10.1034/j.1399... PMid:12485321.
Sethi DS. Immunologic defects in patients with chronic recurrent sinusitis: diagnosis and management.Otolaryngol Head Neck Surg. 1995 Feb;112(2):242-7. https://doi.org/10.1016/S0194-....
Plebani A, Soresina A, Rondelli R, et al. Clinical, immunological, and molecular analysis in a large cohort of patients with X-linked agammaglobulinemia: an Italian Multicenter Study. Clinical Immunology. 2002;104:221–230. https://doi.org/10.1006/clim.2... PMid:12217331.
Gliklich RE, Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg. 1995;113(1):104-9. https://doi.org/10.1016/S0194-....
Wiertsema SP, Veenhoven RH, Sanders EA, et al. Immunologic screening of children with recurrent otitis media. Curr Allergy Asthma Rep. 2005;5(4):302-7. https://doi.org/10.1007/s11882... PMid:15967072.
Finocchi A, Angelini F, Chini L, et al. Evaluation of the relevance of humoral immunedeficiencies in a pediatric population affected by recurrent infections. Pediatr Allergy Immunol. 2002;13(6):443-7. https://doi.org/10.1034/j.1399... PMid:12485321.
Karimi A, Isaiyan A, Aghamohammadi A, Moin M, Zandiyeh F, Dini AT, Abdollahzade S, Tahayi AH, Sazgar AA. Immunological evaluation of children with recurrent ear, nose, and throat (ENT) infections. Iranian Journal of Pediatrics. 2007;17(Suppl 1):5-13.
May A, Zielen S, Von Ilberg C, Weber A. Immunoglobulin deficiency and determination of pneumococcal antibody titers in patients with therapy-refractory recurrent rhinosinusitis. European archives of oto-rhino-laryngology. 1999 Oct 1;256(9):445-9. https://doi.org/10.1007/s00405... PMid:10552223.
Ozkan H, Atlihan F, Genel F, Targan S, Gunvar T. IgA and/or IgG subclass deficiency in children with recurrent respiratory infections and its relationship with chronic pulmonary damage. J Investig Allergol Clin Immunol. 2005 Jan 1;15(1):69-74. PMid:15864886.
de la Morena MT. Clinical phenotypes of hyper-IgM syndromes. The Journal of Allergy and Clinical Immunology: In Practice. 2016 Nov 1;4(6):1023-36. https://doi.org/10.1016/j.jaip... PMid:27836054.
Saki N, Rahim F, Nikakhlagh S, M Sarafraz, E Jafarzadeh. Quality of life in children with recurrent acute otitis media in southwestern of Iran. Indian J Otolaryngol Head Neck Surg 2014; 66:267–70. https://doi.org/10.1007/s12070... PMid:24533396 PMCid:PMC3918277.
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