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Increased respiratory viral detection and symptom burden among patients with primary antibody deficiency: results from the BIPAD study

Ponsford, Mark J., Price, Colin, Farewell, Daniel, Greene, Giles, Moore, Catherine, Perry, Michael, Price, Nicky, Cottrell, Simon, Steven, Rachael, El-Shanawany, Tariq, Carne, Emily, Cousins, Richard, Williams, Paul, Schaub, Alexander, Vonarburg, Cedric and Jolles, Stephen 2021. Increased respiratory viral detection and symptom burden among patients with primary antibody deficiency: results from the BIPAD study. The Journal of Allergy and Clinical Immunology: In Practice 9 (2) , 735-744.e6. 10.1016/j.jaip.2020.08.016

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Background Patients with primary antibody deficiency (PAD) are at increased risk of respiratory tract infections, but our understanding of their nature and consequences remains limited. Objective To define the symptomatic and microbial burden of upper airway infection in adults with PAD relative to age-matched controls. Methods Prospective 12-month observational study consisting of a daily upper and lower airway symptom score alongside fortnightly nasal swab with molecular detection of 19 pathogen targets. Results A total of 44 patients and 42 controls (including 34 household pairs) were recruited, providing more than 22,500 days of symptom scores and 1,496 nasal swabs. Swab and questionnaire compliance exceeded 70%. At enrollment, 64% of patients received prophylactic antibiotics, with a 34% prevalence of bronchiectasis. On average, patients with PAD experienced symptomatic respiratory exacerbations every 6 days compared with 6 weeks for controls, associated with significant impairment of respiratory-specific quality-of-life scores. Viral detections were associated with worsening of symptom scores from a participant's baseline. Patients with PAD had increased odds ratio (OR) for pathogen detection, particularly viral (OR, 2.73; 95% CI, 2.09-3.57), specifically human rhinovirus (OR, 3.60; 95% CI, 2.53-5.13) and parainfluenza (OR, 3.06; 95% CI, 1.25-7.50). Haemophilus influenzae and Streptococcus pneumoniae were also more frequent in PAD. Young child exposure, IgM deficiency, and presence of bronchiectasis were independent risk factors for viral detection. Prophylactic antibiotic use was associated with a lower risk of bacterial detection by PCR. Conclusions Patients with PAD have a significant respiratory symptom burden associated with increased viral infection frequency despite immunoglobulin replacement and prophylactic antibiotic use. This highlights a clear need for future therapeutic trials in the population with PAD, and informs future study design.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an open access article under the CC-BY-NC-ND license.
Publisher: Elsevier
ISSN: 2213-2198
Date of First Compliant Deposit: 26 August 2020
Date of Acceptance: 5 August 2020
Last Modified: 29 Jan 2022 10:53

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