Abstract
Sera from three hundred five patients with immunoglobulin deficiencies were analyzed for the presence of anti-IgA antibodies by using indirect agglutination and enzyme-linked immunosorbent assay (ELISA). Anti-IgA antibodies were observed in 15 of 68 (22%) patients with hypogammaglobulinemia and 53 of 185 (29%) patients with selective IgA deficiency, both groups having serum IgA<0.05 g/liter. The highest frequency, 6 of 10 or 60%, was noted for patients with a combined IgA-IgG2 deficiency. No anti-IgA antibodies were detected in 25 patients with serum IgA between 0.05 and 0.27 g/liter and normal amounts of serum IgM and IgG or in 17 patients with hypogammaglobulinemia who had serum IgA of 0.05–0.7 g/liter. The anti-IgA antibodies were primarily of the IgG class, but IgD and IgM anti-IgA were occasionally found. IgE anti-IgA antibodies could not be detected with the presently used technique. The IgG anti-IgA antibodies were mainly of the IgG1 subclass but occasionally also of the subclasses IgG2, IgG3, and IgG4. Of eight patients with anti-IgA antibodies, seven tolerated Ig prophylaxis with a commercial immunoglobulin preparation low in IgA when given either intramuscularly or intravenously. The titers of anti-IgA in the sera of these patients did not rise in relation to the prophylaxis. Only one of the eight patients had a history of previous anaphylactic reactions to IgA-containing blood products. He tolerated six Ig infusions during 5 months with the IgA-depleted preparation without any adverse effects but showed increasing levels of anti-IgA antibodies and ultimately experienced a near-fatal reaction at the seventh infusion.
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Vyas GN, Perkins HA, Fudenberg HH: Anaphylactoid transfusion reactions associated with anti-IgA. Lancet 2:312–316, 1968
Vyas GN, Holmdahl L, Perkins HA, Fudenberg HH: Serologic specificity of human anti-IgA and its significance in transfusion. Blood 34:573–581, 1969
Vyas GN, Fudenberg HH: Immunobiology of human anti-IgA: A serologic and immunogenetic study of immunization to IgA in transfusion and pregnancy. Clin Genet 1:45–64, 1970
Koistinen J, Cardenas RM, Fudenberg HH: Anti-IgA antibodies of limited specificity in healthy IgA deficient subjects. J Immunogenet 4:295–300, 1977
Strober W, Wochner RD, Barlow MH, McFarlin DE, Waldmann TA: Immunoglobulin metabolism in ataxia-telangiectasia. J Clin Invest 47:1905–1915, 1968
Cassidy JT, Petty R, Burt A, Sullivan D: Anti-IgA antibodies in patients with selective IgA deficiency and connective tissue diseases. Clin Res 17:351, 1969 (abstr)
Natvig JB, Harboe M, Fausa O, Tveit A: Family studies in individuals with selective absence of gamma A-globulin. Clin Exp Immunol 8:299–236, 1971
Nadorp JHS, Voss M, Buys WC, van Munster PJJ, van Tongeren JHM, Aalberse RC, van Loghem E: The significance of the presence of anti-IgA antibodies in individuals with an IgA deficiency. Eur J Clin Invest 3:317–323, 1973
Pai MKR, Davison M, Bedritis I, Zipursky A: Selective IgA deficiency in Rh negative women. Vox Sang 27:87–91, 1974
Koistinen J, Sarna S: Immunological abnormalities in the sera of IgA-deficient blood donors. Vox Sang 29:203–213, 1975
van Munster PJJ, Nadorp JHSM, Schuurman HJ: Human antibodies to immunoglobulin A (IgA). A radioimmunological method for differentiation between anti-IgA antibodies and IgA in the serum of IgA deficient individuals. J Immunol Methods 22:233–245, 1978
Hammarström L, Persson MAA, Smith CIE: Anti-IgA in selective IgA deficiency. In vitro effects and Ig subclass pattern of human anti-IgA. Scand J Immunol 18:509–513, 1983
Clark JA, Callicoat PA, Brenner NA, Bradley CA, Smith DM Jr: Selective IgA deficiency in blood donors. Am J Clin Pathol 80:210–213, 1983
Schmidt AP, Taswell HG, Gleich GJ: Anaphylactic transfusion reactions associated with anti-IgA antibody. N Engl J Med 280:188–193, 1969
Leikola J, Koistinen J, Lehtinen M, Virolainen M: IgA-induced anaphylactic transfusion reactions: A report of four cases. Blood 42:111–119, 1973
Caldera LH, Ropars C, Griscelli C, Homberg JC, Salmon Ch: Anticorps anti-immunoglobulines chez les sujets atteints de dèficit immunitaire. Rev Fr Transfus 16:393–402, 1973
Kamme C, Dahlquist E, Jonsson S, Lindström F: IgG antibodies to IgA in two patients with hypogammaglobulinaemia treated with commercial gammaglobulin. Acta Pathol Microbiol Scand (C) 83:189–194, 1975
Wells JV, Buckley RH, Schanfield MS, Fudenberg HH: Anaphylactic reactions to plasma infusions in patients with hypogammaglobulinemia and anti-IgA antibodies. Clin Immunol Immunopathol 8:265–271, 1977
Koistinen J, Heikkilä M, Leikola J: Gammaglobulin treatment and anti-IgA antibodies in IgA-deficient patients. Br Med J 2:923–924, 1978
Gallagher PE, Buckley RH: Anaphylactic reactions and anti-IgA antibodies in common variable agammaglobulinemia: IgA deficient plasma treatment. J Allergy Clin Immunol 69:120, 1982 (abstr)
Branigan EF, Stevensson MM, Charles D: Blood transfusion reaction in a patient with immunoglobulin A deficiency. Obstet Gynecol 61:47S-49S, 1983
Day NK, Good RA, Wahn V: Adverse reactions in selected patients following intravenous infusions of gamma globulin. Am J Med 76(3A):25–32, 1984
Wahn V, Good RA, Gupta S, Pahwa S, Day NK: Evidence of persistent IgA/IgG circulating immune complexes associated with activation of the complement system in serum of a patient with common variable immunodeficiency: Anaphylactic reactions to intravenous gammaglobulin. Acta Pathol Microbiol Immunol Scand (C) 92 (Suppl 284):49–58, 1984
Burks AW, Sampson HA, Buckley RH: Anaphylactic reactions following gammaglobulin administration in patients with hypogammaglobulinemia (CVA): Detection of IgE antibodies to IgA. N Engl J Med 314:560–564, 1986
Hanson LÅ, Björkander J, Ljunggren C, Oxelius VA, Wadsworth C: Problems with use of immunoglobulins in treatment of immunodeficient patients.In Immunoglobulins: Characteristics and Uses of Intravenous Preparations, BM Alving, FS Finlayson (eds). Washington, DC, U.S. Department of Health and Human Services, DHHS Publ. No. (FDA)-80-9005, 1980, pp 150–159
Rosen FS, Wedgwood RJ, Aiuti F, Cooper MD, Good RA, Hanson LÅ, Hitzig WH, Matsumoto S, Seligman M, Soothill JF, Waldmann TA: Meeting report: Primary immunodeficiency diseases. Clin Immunol Immunopathol 28:450–475, 1983
Björkander J, Wadsworth C, Hanson LÅ: 1040 prophylactic infusions with an unmodified intravenous immunoglobulin product causing few side effects in patients with antibody deficiency syndromes. Infection 13:102–110, 1985
Mancini, G, Carbonara AO, Heremans JF: Immunochemical quantification of antigens by single radial immunodiffusion. Immunochemistry 2:235–254, 1965
Gold ER, Fudenberg HH: Chromic chloride: A coupling reagent for passive hemagglutination reactions. J Immunol 99:857–866, 1967
Persson MAA, Hammarström L, Smith CIE: Enzyme-linked immunosorbent assay for subclass distribution of human IgG and IgA antigenspecific antibodies. J Immunol Methods 78:109–121, 1985
Smith CIE, Hammarström L, Palmblad J: Development of serologically complete IgA deficiency in a patient with common variable hypogammaglobulinemia. J Clin Lab Immunol 17:191–195, 1985
British Medical Research Council: Hypogammaglobulinaemia in the United Kingdom. Spec Rep Ser No. 310. London, Her Majesty's Stationary Office, 1971
Barandun S, Kistler P, Jeunet F, Isliker H: Intravenous administration of human gammaglobulin. Vox Sang 7:157–174, 1962
Björkander J: Antibody Deficiency Syndromes, Dissertation. Göteborg, University of Göteborg, 1985
Hammarström L, Smith CIE: Pathogenesis of anaphylactic reactions to IgA containing blood products in immunodeficient donors. N Engl J Med 315:519, 1986
Shakib F, Stanworth DR: IgG4: A possible mediator of anaphylaxis in a hameophiliac patient. Clin Allergy 9:597–603, 1979
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Björkander, J., Hammarström, L., Smith, C.I.E. et al. Immunoglobulin prophylaxis in patients with antibody deficiency syndromes and anti-IgA antibodies. J Clin Immunol 7, 8–15 (1987). https://doi.org/10.1007/BF00915419
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DOI: https://doi.org/10.1007/BF00915419