Warning signs of primary immunodeficiencies: is there any benefits?
https://doi.org/10.15789/1563-0625-WSO-2144
Abstract
Primary immunodeficiencies is a group of diseases resulting from a variety of genetic defects. At the moment, more than 300 immunodeficiencies are known, most of which negatively affect the quality and duration of life, leading to deaths in the first year of a child's life. The most severe and at the same time quite frequent are defects in cellular immunity. It is currently known that the incidence of clinically significant T lymphopenias is 1: 4000 live newborns, and the incidence of clinically significant cellular primary immunodeficiencies is 1: 10000 live newborns. Despite the extensive treatment options for these diseases, patient survival is low. This is a consequence of the delayed setting of the correct diagnosis and, accordingly, the beginning of adequate therapy. Early detection of primary immunodeficiencies is a key factor in the successful treatment of patients with these diseases. Despite the fact that clinical warning signs were formulated more than 25 years ago, and their promotion is incredibly successful, the correct diagnosis is delayed for most immunodeficient patients by years. This situation is a consequence of an extremely wide range of clinical manifestations of immunodeficiencies. At the moment, there are several lists of warning signs. There is also an approach in which alarming clinical signs are formulated separately for different specialists. All of these lists are the result of attempts to increase the sensitivity and specificity of this instrument. These attempts each time turned out to be unsuccessful, since they slightly increased its effectiveness. The work of immunologists from Great Britain, Germany, Egypt, USA showed that it is almost impossible to formulate a list of warning signs from only clinical and anamnestic indicators. Apparently, it is necessary to add screening laboratory techniques.
About the Author
I. A. KorsunskiyRussian Federation
Ilya Korsunskiy - PhD (Medicine), Head, Center for Allergology and Immunology.
141014, Moscow region, Mytischi, 3rd Krestyanskaya str., 9, apt 109. Phone: 7 (903) 571-77-85
Competing Interests:
no
References
1. Korsunskiy I.A., Gordukova M.A., Smirnova A.S., Munblit D.B., Davydova N.V., Kozlov I.G., Prodeus A.P., Korsunskiy A.A., Rumyantsev A.G. Feasibility of Neonatal Screening for Primary Immunodeficiencies. RMZh = Russian Medical Journal, 2018, no. 9, pp. 29-32. (In Russ.)
2. Al-Herz W., Nanda A. Skin Manifestations in Primary Immunodeficient Children. Pediatr. Dermatol., 2011, Vol. 28, no. 5, pp. 494-501.
3. Arason G.J., Jorgensen G.H., Ludviksson B.R. Primary Immunodeficiency and Autoimmunity: Lessons From Human Diseases. Scand. J. Immunol., 2010, Vol. 71, no. 5, pp. 317-328.
4. Arkwright P.D., Gennery A.R. Ten warning signs of primary immunodeficiency: a new paradigm is needed for the 21st century. Ann. N. Y. Acad. Sci., 2011, Vol. 1238, no. 1, pp. 7-14.
5. Arslan S., Ucar R., Caliskaner AZ., Reisli I., Guner S.N., Sayar E.H., Baloglu I. How effective are the 6 European Society of Immunodeficiency warning signs for primary immunodeficiency disease? Ann. Allergy, Asthma Immunol., 2016, Vol. 116, no. 2, pp. 151-155.e1.
6. Bjelac J.A., Yonkof J.R., Fernandez J. Differing Performance of the Warning Signs for Immunodeficiency in the Diagnosis of Pediatric Versus Adult Patients in a Two-Center Tertiary Referral Population. J. Clin. Immunol., 2019, Vol. 39, no. 1, pp. 90-98.
7. Chu E.Y. Freeman A.F., Jing H., Cowen E.W., Davis J., Su H.C., Holland S.M., Turner M.L.C. Cutaneous Manifestations of DOCK8 Deficiency Syndrome. Arch. Dermatol., 2012, Vol. 148, no. 1, pp. 79-84.
8. Condino-Neto A., Franco J.L., Trujillo-Vargas C., Espinosa-Rosales F.J., Leiva L.E., Rodriguez-Quiroz F., King A., Lagos M., Oleastro M., Bezrodnik L., Grumach A.S., Costa-Carvalho B.T., Sorensen R.U. Critical issues and needs in management of primary immunodeficiency diseases in Latin America. Allergol. Immunopathol. (Madr.), 2011, Vol. 39, no. 1, pp. 45-51.
9. Costa-Carvalho B.T., Grumach A.S., Franco J.L., Espinosa-Rosales F.J., Leiva L.E., King A., Porras O., Bezrodnik L., Oleastro M., Sorensen R.U., Condino-Neto A. Attending to warning signs of primary immunodeficiency diseases across the range of clinical practice. J. Clin. Immunol., 2014, Vol. 34, no. 1, pp. 10-22.
10. Cunningham-Rundles C., Brandeis W.E., Pudifin D.J., Day N.K., Good R.A. Autoimmunity in selective IgA deficiency: relationship to anti-bovine protein antibodies, circulating immune complexes and clinical disease. Clin. Exp. Immunol., 1981, Vol. 45, no. 2, pp. 299-304.
11. de Vries E. in collaboration with European Society for Immunodeficiencies (ESID) members. Patient-centred screening for primary immunodeficiency, a multi-stage diagnostic protocol designed for non-immunologists: 2011 update. Clin. Exp. Immunol., 2012, Vol. 167, no. 1, pp. 108-119.
12. Farmand S., Baumann U., von Bernuth H., Borte M., Foerster-Waldl E., Franke K., Habermehl P., Hapaun P., Klock G., Liese J., Marks R., Nebe T., Niehues T., Schuster V., Harnatz K., Witte T., Ehl S., Schulze I. Interdisziplinäre AWMF-Leitlinie zur Diagnostik von primären Immundefekten (S2k). Klin. Pädiatr., 2011, Vol. 223, no. 06, pp. 378-385.
13. Kobrynski L.J.J., Mayer L. Diagnosis and treatment of primary immunodeficiency disease in patients with gastrointestinal symptoms. Clin. Immunol., 2011, Vol. 139, no. 3, pp. 238-248.
14. Lankisch P., Schiffner J., Ghosh S., Babor F., Borkhardt A., Laws H.J. The Duesseldorf warning signs for primary immunodeficiency: is it time to change the rules? J. Clin. Immunol., 2015, Vol. 35, no. 3, pp. 273-279.
15. MacGinnitie A., Aloi F., Mishra S. Clinical characteristics of pediatric patients evaluated for primary immunodeficiency. Pediatr. Allergy Immunol., 2011, Vol. 22, no. 7, pp. 671-675.
16. Modell V., Gee B., Lewis D.B., Orange J.S., Roifman C.M., Routes J.M., Sorensen R.U., Notarangelo L.D., Modell F. Global study of primary immunodeficiency diseases (PI) – diagnosis, treatment, and economic impact: an updated report from the Jeffrey Modell Foundation. Immunol. Res., 2011, Vol. 51, no. 1, pp. 61-70.
17. Moraes-Vasconcelos D., Costa-Carvalho B.T., Torgerson T.R., Ochs H.D. Primary immune deficiency disorders presenting as autoimmune diseases: IPEX and APECED. J. Clin. Immunol., 2008, Vol. 28, no. S1, pp. 11-19.
18. Notarangelo L., Casanova J.L., Fischer A., Puck J., Rosen F., Seger R., Geha R., International Union of Immunological Societies Primary Immunodeficiency diseases classification committee. Primary immunodeficiency diseases: An update. J. Allergy Clin. Immunol., 2004, Vol. 114, no. 3, pp. 677-687.
19. O’Sullivana M.D., Cant A.J. The 10 warning signs: A time for a change? Curr. Opin. Allergy Clin. Immunol., 2012, Vol. 12, no. 6, pp. 588-594.
20. Peshko D., Titova E., Korsunskiy I., Kondrikova E., Pulvirenti F., Quinti I., Blyuss O., Galvin A.D., Munblit D. Health-related quality of life in children and adults with primary immunodeficiencies: a systematic review and meta-analysis. J. Allergy Clin. Immunol. Pract., 2019, Vol. 7, no. 6, pp. 1929-1957.
21. Picard C., von Bernuth H., Ghandil P., Chrabieh M., Levy O., Arkwright P.D., McDonald D., Geha R.S., Takada H., Krause J.C., Buddy Creech C., Ku C.L., Ehl S., Maródi L., Al-Muhsen S., Al-Hajjar S., Al-Ghonaium A., Day-Good N.K., Holland S.M., Gallin J.I., Chapel H., Speert D.P., Rodriguez-Gallego C., Colino E., Ben-Zion G., Roifman C., Hara T., Yoshikawa H., Nonoyama S., Domachowske J., Issekutz A.C., Tang M., Smart J., Zitnik S.E., Hoarau C., Kumararatne D.S., Thrasher A.J., Davies E.G., Bethune C., Sirvent N., de Ricaud D., Camcioglu Y., Vasconcelos J., Guedes M., Bonito V.A., Rodrigo C., Almazán F., Méndez M., Aróstegui J.I., Alsina L., Fortuny C., Reichenbach J., Verbsky J.W., Bossuyt X., Doffinger R., Abel L., Puel A., Casanova J.L. Clinical features and outcome of patients With IRAK-4 and MyD88 deficiency. Medicine, 2010, Vol. 89, no. 6, pp. 403-425.
22. Pickett D., Modell V., Leighton I., Modell F. Impact of a physician education and patient awareness campaign on the diagnosis and management of primary immunodeficiencies. Immunolo. Res., 2008, Vol. 40, no. 1, pp. 93-94.
23. Reda S.M., El-Ghoneimy D.H., Afifi H.M. Clinical Predictors of Primary Immunodeficiency Diseases in Children. Allergy Asthma Immunol. Res., 2013, Vol. 5, no. 2, pp. 88-95.
24. Sediva A., Bataneant M., Belevtsev M., Blaziene A., Ciznar P., Förster-Waldl E., Kelecic J., Marodi J., Naumova E., Nasrullayeva G., Ress K., Serban M., Sitkauskiene B., Toth B., Modell V., Modell F., Tenembaum V., Marković M., Avcin T. Primary immunodeficiencies in Central and Eastern Europe – the power of networking Report on the activity of the Jeffrey Modell Foundation Centers Network in Central and Eastern Europe. Immunol. Res., 2019, Vol. 67, no. 4-5, pp. 358-367.
25. Soler-Palacín P., de Gracia J., González-Granado L.I., Martín C., Rodríguez-Gallego C., Sánchez-Ramón S., Lung ID-Signal Group. Primary immunodeficiency diseases in lung disease: warning signs, diagnosis and management. Respir. Res., 2018, Vol. 19, no. 1, 219. doi: 10.1186/s12931-018-0923-8.
26. Subbarayan A., Colarusso G., Hughes S.M., Gennery A.R., Slatter M., Cant A.J., Arkwright P.D. Clinical Features That Identify Children With Primary Immunodeficiency Diseases. Pediatrics, 2011, Vol. 127, no. 5, pp. 810-816.
27. Wahn V. Das infektanfällige Kind. HNO, 2000, Vol. 48, no. 3, pp. 231-234.
Supplementary files
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For citations:
Korsunskiy I.A. Warning signs of primary immunodeficiencies: is there any benefits? Medical Immunology (Russia). 2021;23(6):1405-1414. (In Russ.) https://doi.org/10.15789/1563-0625-WSO-2144