Antibody production deficiency with normal IgG levels in bronchiectasis of unknown etiology

Chest. 2005 Jan;127(1):197-204. doi: 10.1378/chest.127.1.197.


Background: No defined cause of bronchiectasis is currently found in approximately 50% of cases. Bronchiectasis is a common long-term complication in patients with primary hypogammaglobulinemia.

Study objectives: To ascertain whether antibody production deficiency with normal total serum IgG levels is associated with bronchiectasis.

Design: Antibody response to a pneumococcal unconjugate vaccine and an Haemophilus influenzae type b conjugate vaccine was prospectively studied in all consecutive adult patients with bronchiectasis of unknown etiology who were assessed in our chest outpatient clinic from January 1994 to October 2001. Serum-specific antibodies were measured by enzyme-linked immunosorbent assay, and the results were compared with those obtained in a healthy adult control group. Antibody production deficiency was defined as a failure to respond to either vaccine.

Results: One hundred seven patients were included in the study (mean age, 46.3 years). Antibody production deficiency was diagnosed in 12 patients (11%). A significantly higher incidence of otitis media, lower serum IgG2 subclass levels, and lower preimmunization antibody levels to Streptococcus pneumoniae and H influenzae type b were observed in patients with antibody production deficiency. The probability of antibody production deficiency in patients with a history of otitis media was 20%, 26% in those with low IgG2 subclass levels, and 58% in those with both a history of otitis media and low IgG2 subclass levels.

Conclusions: Antibody production deficiency with normal IgG levels may be associated with bronchiectasis, making it advisable to evaluate the antibody response to both the H influenzae and pneumococcal vaccines in patients with bronchiectasis of unknown etiology, particularly in those with a history of otitis media, low IgG2 subclass levels, and low levels of baseline specific antibodies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Bacterial / analysis
  • Bronchiectasis / blood*
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Haemophilus influenzae type b / immunology
  • Humans
  • Immunoglobulin G / blood*
  • Male
  • Middle Aged
  • Otitis Media / immunology
  • Pneumococcal Vaccines
  • Prospective Studies
  • Streptococcus pneumoniae / immunology
  • Vaccines, Conjugate


  • Antibodies, Bacterial
  • Immunoglobulin G
  • Pneumococcal Vaccines
  • Vaccines, Conjugate