Q:

1/8/2013
Is there any benefit of giving Prevnar-13 in established Hypogamm pt/s on IVIG? As I recall most CVID/Hypogamm pt's have T cell (IL-2) dysfucn. etc and are unable to mount good polysacc. antigen immune response. That's the reason why they are on IVIG replacement Rx. Same applies if Flu shot is helpful?

Read data which supports lack of efficacy of some vaccines and all push from drug companies to keep pushing vaccinations to make $$'s. Will appreciate your feedback.

A:

Thank you for your inquiry.

Perhaps the best way to answer your question is to refer you to the report of the Working Group of the American Academy of Allergy, Asthma, and Immunology on the interpretation of diagnostic vaccination (1).

Summary Statement 31 from this text is copied for you below:

“Summary Statement 31: PCV7 or PCV13 protein conjugate vaccines can be administered to patients who have a poor response to PPV23. (III C)

A response to PCV suggests that the subject is able to respond preferentially to protein antigens but does not alter the diagnosis of selective antibody deficiency.91, 92 PPV vaccination can boost the preexisting antibody response to the serotypes present in the PCV vaccine.73, 74”

Common variable immunodeficiency has varying pathogenesis and different degrees of T cell deficiency. In my opinion, it would certainly do no harm, and in some cases may help to immunize to PCV-13 in these patients. And although response to any vaccination would, of course, be blunted in patients with common variable immunodeficiency, innocuous vaccinations such as to influenza are in no way hurtful, and possibly helpful.

Thank you again for your inquiry and we hope this response is helpful to you.

References:
1. Use and interpretation of diagnostic vaccination in primary immunodeficiency: A working group report of the Basic and Clinical Immunology Interest Section of the American Academy of Allergy, Asthma & Immunology. The Journal of Allergy and Clinical Immunology Vol. 130, Issue 3, Supplement, Pages S1-S24, 2012.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology