Valentin Popa

Immediate hypersensitivity in adults with IgG deficiency and recurrent respiratory infections

BACKGROUNDnLittle is known about the prevalence of atopy in adults with recurrent respiratory infections and IgG deficiency.nnnOBJECTIVE AND METHODSnTo elucidate this aspect, we skin-tested 95 consecutive adults with respiratory infections, subnormal levels of IgG subclasses or common variable immunodeficiency and usually poor response to vaccination. In 50 subjects we also measured total IgE.nnnRESULTSnWe found 67 subjects with IgG subclass deficiency, 21 subjects with mild (partial) and 5 with usual common variable immunodeficiency, and 2 subjects with functional IgG deficiency. Atopy was encountered in 42/95 subjects, 33/44 (75%) with asthma, 7/19 (38%) with isolated rhinosinusitis, 1/27 (4%) with chronic obstructive lung disease, and 1/5 (20%) with both the latter disease and asthma, respectively. Atopy was preferentially clustered in subjects with asthma (P < .05) who were less than 40 years of age (P < .05) and nonsmoking. Atopy was not affected by the type of IgG deficiency, unless it was usual common variable immunodeficiency, in which case the skin tests tended to be negative (4/5). Total IgE was within normal range but less elevated than usually seen in asthma or chronic obstructive lung disease. Total IgE was independent of the type of IgG deficiency, except for usual common variable immunodeficiency in which it remained < 10 IU/mL.nnnCONCLUSIONSnIn adults with symptomatic IgG deficiency, the prevalence of immediate hypersensitivity and its modulation by age and smoking are similar to the referred, non-IgG deficient population; however, total IgE may be lower in the former than in the latter. In common variable immunodeficiency, consistent with the literature data, both the prevalence of atopy and serum total IgE are decreased.

Wheezing triggered by dorsal decubitus : pulmonary function changes

UNLABELLEDnIn 23 subjects with chronic obstructive pulmonary disease (COPD) who wheezed when changing their position from sitting to dorsal decubitus (DD), we recorded lung volumes and flow volume loops in sitting (S1), DD and immediately after resuming sitting (S2). We found three main patterns of ventilatory changes associated with wheezing in DD: (1) acute obstruction (AO) in 14 subjects characterized by FEV1 > or = -10% and %FEV1/FVC > or = -3%; functional residual capacity or residual volume was increased, decreased or unchanged; (2) acute restriction (AR) in 7 subjects characterized by absence of obstruction spirographically and FVC and/or FRC > -10%; (3) indeterminate response (IR) in 2 subjects. Except for 3 subjects, the changes recorded in DD returned to baseline in S2. Both AO and AR responses in DD and their rapid resolution in S2 were reproducible (11 subjects).nnnIN CONCLUSIONn(1) in COPD, DD may trigger wheezing; (2) the physiologic changes during DD wheezing are reproducible, rapidly reversible when the sitting position is resumed and unlike those recorded during bronchoprovocation, heterogeneous.