Antibody deficiency in bronchiectasis
2005
To the Editors:
We have read with interest the article by van Kessel et al . 1 on impaired antibody response to the pneumococcal polysaccharides of Streptococcus pneumoniae in patients with bronchiectasis of unknown aetiology. Several aspects of this work are controversial and there is no unanimous agreement on some of their conclusions. The first aspect that merits attention is the lack of a control group to establish the normal total antibody response and the isotypes to the vaccine, and, consequently, the diagnostic criteria of impaired antibody response. There are no universal criteria for adequate antibody response to polysaccharides and each laboratory should establish its own 2. This is particularly important because of the therapeutic implications. Treatment of symptomatic patients with a lack of antibody response is performed with periodic administration of intravenous immunoglobulins (Ig) at a high cost, dependent on healthcare centres and potential side-effects 3. For this reason, strict diagnostic criteria must be established.
It is interesting to note that van Kessel et al . 1 used different criteria for the response with total antibodies to the serotypes 3, 4 and 9V, in which the post-vaccination titre should be >20 U·mL−1 with at least a two-fold increase for two of the three …
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