Q:

1/17/2014
I recently consulted on a 47yo fem with a history consistent with Crohn’s Disease however, bx have not confirmed the dx. She has been suffering from a recalcitrant perianal abscess despite I n D and multiple abx. She is under the care of an infectious disease specialist. The gastroenterologist wants to proceed with treatment with Humira and sent her to another immunologist who performed an immunologic evaluation. The only abnormality was a diminished mannose binding lectin assay. All other immune assays were nl including lymphocyte enumeration, mitogens and humoral immunity. Other than the fact that she has this ongoing infection, do you feel a markedly diminished MBL level would be a clear contraindication to proceed with the TNF inhibitor?

A:

Thank you for your inquiry.

I am not an expert in this area and could not find anything with a literature search that might be helpful. Therefore I am calling on Dr. Damon Eisen, who is an international expert in mannose-binding lectin deficiency, for his help. When we receive Dr. Eisen's response, we will forward it to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Damon Eisen. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Damon Eisen:
MBL deficiency doesn't clearly predispose to infections with tuberculosis which would be the concern with Humira treatment. I’ve published on the link between MBL and TB and we couldn't clearly find one. If anything it would be more logical that people with high MBL would be more at risk of TB as it may potentiate greater phagocytosis of the organism.

As long as the patient is not IGRA positive I don't see a contraindication from MBL deficiency.

Kind regards,
Damon Eisen
 

AAAAI - American Academy of Allergy Asthma & Immunology