Comparison of Reference Systems in the Assessment of Age-related Serum Immunoglobulin Levels in Pediatric Patients

Overview

Journal Turk J Med Sci

Specialty General Medicine

Date 2019 Feb 16

PMID 30764591

Authors

Ilknur Kulhas Celik

Ersoy Civelek

Ayse Metin

Tayfur Ginis

Muge Toyran

Emine Dibek Misirlioglu

Can Naci Kocabas

Affiliations

Soon will be listed here.

Abstract

Background/aim: Ig level assessment is frequently used in the diagnosis and follow-up of immunodeficiency, as well as in studies investigating the prevalence of low serum Ig level in specific diseases.

Materials And Methods: Patients who underwent Ig testing in the inpatient and outpatient clinics of our hospital in the years 2010–2016 were included. The Ig levels of the patients were assessed separately according to two reference systems commonly used in Turkey and another reference system used in the USA.

Results: A total of 20,138 patients (57.6% male) were included in the study. The median age of the patients was 55.7 months (interquartile range: 23.1–96.7). According to the reference intervals determined by Tezcan et al., 30.6% of the patients were deficient in one or more Ig values. This rate was 4 times higher than those based on the reference intervals determined by Aksu et al. (7.7%) and those in the Nelson Textbook of Pediatrics (6.8%). We also determined that the frequency of low Ig levels with three reference systems

Conclusion: In this study, we found that the rates of low Ig level in a group of pediatric patients differed significantly when evaluated using three different reference systems for age-related serum Ig levels

References

Aksu G, Genel F, Koturoglu G, Kurugol Z, Kutukculer N . Serum immunoglobulin (IgG, IgM, IgA) and IgG subclass concentrations in healthy children: a study using nephelometric technique. Turk J Pediatr. 2006; 48(1):19-24. View

Oliveira J, Fleisher T . Laboratory evaluation of primary immunodeficiencies. J Allergy Clin Immunol. 2010; 125(2 Suppl 2):S297-305. PMC: 3412511. DOI: 10.1016/j.jaci.2009.08.043. View

Notarangelo L . Primary immunodeficiencies. J Allergy Clin Immunol. 2010; 125(2 Suppl 2):S182-94. DOI: 10.1016/j.jaci.2009.07.053. View

Ercan H, Ispir T, Kirac D, Baris S, Ozen A, Oztezcan S . Predictors of atopic dermatitis phenotypes and severity: roles of serum immunoglobulins and filaggrin gene mutation R501X. Allergol Immunopathol (Madr). 2012; 41(2):86-93. DOI: 10.1016/j.aller.2012.03.004. View

Bonilla F, Khan D, Ballas Z, Chinen J, Frank M, Hsu J . Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015; 136(5):1186-205.e1-78. DOI: 10.1016/j.jaci.2015.04.049. View

Denham E, Mohn B, Tucker L, Lun A, Cleave P, Boswell D . Evaluation of immunoturbidimetric specific protein methods using the Architect ci8200: comparison with immunonephelometry. Ann Clin Biochem. 2007; 44(Pt 6):529-36. DOI: 10.1258/000456307782268237. View

Lock R, Unsworth D . Immunoglobulins and immunoglobulin subclasses in the elderly. Ann Clin Biochem. 2003; 40(Pt 2):143-8. DOI: 10.1258/000456303763046067. View

Yel L, Rabbat C, Cunningham-Rundles C, Orange J, Torgerson T, Verbsky J . A Novel Targeted Screening Tool for Hypogammaglobulinemia: Measurement of Serum Immunoglobulin (IgG, IgM, IgA) Levels from Dried Blood Spots (Ig-DBS Assay). J Clin Immunol. 2015; 35(6):573-82. PMC: 4572045. DOI: 10.1007/s10875-015-0184-y. View

Lau Y, Jones B, Ng K, Yeung C . Percentile ranges for serum IgG subclass concentrations in healthy Chinese children. Clin Exp Immunol. 1993; 91(2):337-41. PMC: 1554695. DOI: 10.1111/j.1365-2249.1993.tb05905.x. View

10.

Modell V, Gee B, Lewis D, Orange J, Roifman C, Routes J . Global study of primary immunodeficiency diseases (PI)--diagnosis, treatment, and economic impact: an updated report from the Jeffrey Modell Foundation. Immunol Res. 2011; 51(1):61-70. DOI: 10.1007/s12026-011-8241-y. View

11.

van den Akker E, Sanders E, van Staaij B, Rijkers G, Rovers M, Hoes A . Long-term effects of pediatric adenotonsillectomy on serum immunoglobulin levels: results of a randomized controlled trial. Ann Allergy Asthma Immunol. 2006; 97(2):251-6. DOI: 10.1016/S1081-1206(10)60022-1. View

12.

Baris S, Karakoc-Aydiner E, Ozen A, Ozdemir C, Bahceciler N, Barlan I . Serum immunoglobulin levels as a predictive factor for a better outcome of non-atopic childhood asthma. Pediatr Allergy Immunol. 2010; 22(3):298-304. DOI: 10.1111/j.1399-3038.2010.01105.x. View

13.

Schauer U, Stemberg F, Rieger C, Borte M, Schubert S, Riedel F . IgG subclass concentrations in certified reference material 470 and reference values for children and adults determined with the binding site reagents. Clin Chem. 2003; 49(11):1924-9. DOI: 10.1373/clinchem.2003.022350. View

14.

Plebani A, Ugazio A, Avanzini M, Massimi P, Zonta L, Monafo V . Serum IgG subclass concentrations in healthy subjects at different age: age normal percentile charts. Eur J Pediatr. 1989; 149(3):164-7. DOI: 10.1007/BF01958271. View

15.

Solberg H . The IFCC recommendation on estimation of reference intervals. The RefVal program. Clin Chem Lab Med. 2004; 42(7):710-4. DOI: 10.1515/CCLM.2004.121. View

16.

Blirup-Jensen S . Protein standardization III: Method optimization basic principles for quantitative determination of human serum proteins on automated instruments based on turbidimetry or nephelometry. Clin Chem Lab Med. 2002; 39(11):1098-109. DOI: 10.1515/CCLM.2001.175. View

17.

Vlug A, Nieuwenhuys E, van Eijk R, Geertzen H, van Houte A . Nephelometric measurements of human IgG subclasses and their reference ranges. Ann Biol Clin (Paris). 1994; 52(7-8):561-7. View