[Re: ] polysaccharide abs

[Guest guest]

's ped called today with the meningococcal titers. I never called him to

check on them... I never wanted the vaccine or the test, felt they were a

waste of time. Funny thing is I figured she probably wouldn't have a normal

response, but now I'm upset because of how bad the response was. I honestly feel

I

would have been better off not knowing!

All the titers are in the " pre-vaccinated " level range, no protective numbers

at all. He seemed flummoxed. Then he brightened, came up with an idea. Said,

" Hey! There's a new vaccine, just came out, it's a CONJUGATED version of the

vaccine. " I said, " Doctor, that's the vaccine you GAVE her, the conjugated

version. " He said incredulously, " These titers are for the CONJUGATED

vaccine????? " and was just stunned. He seemed to flip through some paper and

confirm this.

He sounded so sweetly disappointed. I felt bad for HIM! It's like I had to

talk him down from the ledge, I said, " Well, it stinks but it isn't really very

surprising, considering she doesn't respond to Prevnar, I mean, meningococcal

bacteria is encapsulated also, isn't it? " Here I am, the parent, explaining to

the doc why it isn't so shocking she didn't respond. Funny. I mean, I don't

expect him to memorize 's history, but I think they only have one other

PID patient, you'd think at least the diagnosis might stick.

So anyway, he then was so at a loss for words that I found myself reassuring

HIM... " We're still hoping maybe it will kick in at some point... maybe

puberty... " then I rambled on, " She's had a really great summer!! Her summers

are

always very healthy, it's wonderful. "

Isn't that a scream! He still sounded hesitant and puzzled when he let me go.

I found myself more disappointed than I expected, because after all, at least

at this point after something like six or eight Prevnars, has at least

had some blips here and there and gets some up in the protective range at

least for a short time.

I'm confused how she hasn't had any more deep-seated infections if her

response is this bad. I mean, I know when she had meningitis it was due to an

unresolved, resistant ear infection and we NEVER give those a chance to get that

far

anymore. Maybe that's the key, not letting anything get by. But it just seems

like you'd expect her to get more serious infections than she does.

The immune system is so mysterious... she catches so many viruses so much

worse than her sister, and yet nothing in her blood work explains that. And if

her response to polysaccharides is so bad, why does she never get anything too

horrible? I mean, for the most part, usually a normal course of abx does the

trick. Not that I'm complaining!!!!!

Something that always bothered me. I understand why she wouldn't respond to a

pure polysaccharide. But why does she not respond to the Conjugated version?

I mean, I remember that whatever the protein is that they conjugate Prevnar

with (is it diptheria?), had normal titers to the protein (diptheria, or

whatever it is). Can anybody explain this very basic question about my own

daughter's dx that I never got any doc to explain before?

(mom to , age 6-1/2, dairy intolerant-related GERD -- currently

has polysaccharide antibody def, previously had transient IgG, IgA, t-cell &

other defs... and also to Kate, age 2-1/2, more dairy intolerant but very

healthy!)

[Guest guest]

:

Thank you for clipping that article. The meningococcal bacteria is

gram-negative, the pneumococcal is gram-positive. The trait they share is the

sugar

capsule, they are both encapsulated.

I wonder if Prevnar and the conjugated meningococcal vaccine are both

conjugated with the same protein??

I was sort of settled down with time... has not been seriously ill with

her current diagnosis (5 years) and I have gotten nicely complacent about her

condition. Hearing about her lack of response to this new vaccine has me

worrying about her all over again.

Don't get me wrong, we don't live carefree, easy lives -- we are always

missing important events due to illness, she gets sick alot and suffers during

the

school year. It is hard to see her sick so often and I worry about repeated

LRIs. But really, compared to so many pumpkins, she doesn't get seriously ill

and responds to oral abx most of the time. So then I feel guilty for being

concerned or possibly seeming like I don't appreciate how " good " we have it. My

SIL

adds to this when she makes comments about how will be sick with

something, that she'll think to herself, " Well, MY kids get that... " etc. etc.

She

drives me nuts, that woman. I know she could just be trying to make me feel

better and not worry by saying her kids get the same illnesses, but I don't

think

her kids' one ear infection a year is exactly the same as 's illness

rate. But I can't argue that or it sounds like I'm " competing " , like saying my

kid is sicker than your kid, which just sounds sick! She's a frustrating person,

very competitive and dramatic and loud and always seeking attention, making

up stories and exaggerating to make a great story. But she ACTS so nice and

thoughtful, then you let your guard down and she zings you with some comment

that

isn't quite as nasty as it could be, so you can't really call her on it or

you look paranoid. Urrrrrgh. I've about had it with her and at the moment I can

barely stand to talk to her. But she calls me all the time!

Calgon take me away... from the phone!

(mom to , age 6-1/2, dairy intolerant-related GERD -- currently

has polysaccharide antibody def, previously had transient IgG, IgA, t-cell &

other defs... and also to Kate, age 2-1/2, more dairy intolerant but very

healthy!)

[Guest guest]

" I understand why she wouldn't respond to a pure polysaccharide. But why does

she not respond to the Conjugated version "

Just wondering...was ever check for isohemagluttins? I don't know much

about encapsuled bacteria with regard to them being gram neg or pos.

This is from Merck:

Biologic properties of antibodies: The amino acid structure of the C region of

the heavy chain determines the isotype of that Ig class. Each class serves

different functions.

IgM, the first Ab formed after primary immunization (exposure to new Ag),

protects the intravascular space from disease. Pentameric IgM molecules readily

activate complement and serve as opsonizers and agglutinators to assist the

phagocytic system to eliminate many kinds of microorganisms. Isohemagglutinins

and many Abs to gram-negative organisms are IgM. Monomeric IgM serves as an Ag

receptor on the B-cell membrane.

IgG, the most prevalent type of serum Ab, is also found in extravascular spaces;

it is produced when IgM titers begin to decrease after primary immunization. IgG

is the major Ig produced after re-immunization (the memory immune response or

secondary immune response). IgG protects the tissues from bacteria, viruses, and

toxins. IgG is the only Ig that crosses the placenta. Different subclasses of

IgG neutralize bacterial toxins, activate complement, and enhance phagocytosis

by opsonization. Commercial -globulin is almost entirely IgG, with small amounts

of other Igs.

IgA is found in mucous secretions (saliva, tears, respiratory, GU and GI tract,

and colostrum), where it provides an early antibacterial and antiviral defense.

Secretory IgA is synthesized in the subepithelial regions of the GI and

respiratory tracts and is present in combination with locally produced secretory

component (SC). Few cells that produce IgA are found in the lymph nodes and

spleen. Serum IgA does not contain SC. Serum IgA provides protection against

Brucella, diphtheria, and poliomyelitis.

IgD is present in serum in extremely low concentrations but also appears on the

surface of developing B cells and may be important in their growth and

development.

IgE (reaginic, skin-sensitizing, or anaphylactic Ab), like IgA, is found

primarily in respiratory and GI mucous secretions. In serum, IgE is present in

very low concentrations. IgE interacts with mast cells; bridging of two IgE

molecules by allergen may cause degranulation of the cells, with the release of

chemical mediators that cause an allergic response. IgE levels are elevated in

atopic diseases (eg, allergic or extrinsic asthma, hay fever, and atopic

dermatitis), parasitic diseases, far-advanced Hodgkin's disease, and

IgE-monoclonal myeloma. IgE may have a beneficial role in the defense against

parasites.

bunneegirl@... wrote:

's ped called today with the meningococcal titers. I never called him to

check on them... I never wanted the vaccine or the test, felt they were a

waste of time. Funny thing is I figured she probably wouldn't have a normal

response, but now I'm upset because of how bad the response was. I honestly feel

I

would have been better off not knowing!

All the titers are in the " pre-vaccinated " level range, no protective numbers

at all. He seemed flummoxed. Then he brightened, came up with an idea. Said,

" Hey! There's a new vaccine, just came out, it's a CONJUGATED version of the

vaccine. " I said, " Doctor, that's the vaccine you GAVE her, the conjugated

version. " He said incredulously, " These titers are for the CONJUGATED

vaccine????? " and was just stunned. He seemed to flip through some paper and

confirm this.

He sounded so sweetly disappointed. I felt bad for HIM! It's like I had to

talk him down from the ledge, I said, " Well, it stinks but it isn't really very

surprising, considering she doesn't respond to Prevnar, I mean, meningococcal

bacteria is encapsulated also, isn't it? " Here I am, the parent, explaining to

the doc why it isn't so shocking she didn't respond. Funny. I mean, I don't

expect him to memorize 's history, but I think they only have one other

PID patient, you'd think at least the diagnosis might stick.

So anyway, he then was so at a loss for words that I found myself reassuring

HIM... " We're still hoping maybe it will kick in at some point... maybe

puberty... " then I rambled on, " She's had a really great summer!! Her summers

are

always very healthy, it's wonderful. "

Isn't that a scream! He still sounded hesitant and puzzled when he let me go.

I found myself more disappointed than I expected, because after all, at least

at this point after something like six or eight Prevnars, has at least

had some blips here and there and gets some up in the protective range at

least for a short time.

I'm confused how she hasn't had any more deep-seated infections if her

response is this bad. I mean, I know when she had meningitis it was due to an

unresolved, resistant ear infection and we NEVER give those a chance to get that

far

anymore. Maybe that's the key, not letting anything get by. But it just seems

like you'd expect her to get more serious infections than she does.

The immune system is so mysterious... she catches so many viruses so much

worse than her sister, and yet nothing in her blood work explains that. And if

her response to polysaccharides is so bad, why does she never get anything too

horrible? I mean, for the most part, usually a normal course of abx does the

trick. Not that I'm complaining!!!!!

Something that always bothered me. I understand why she wouldn't respond to a

pure polysaccharide. But why does she not respond to the Conjugated version?

I mean, I remember that whatever the protein is that they conjugate Prevnar

with (is it diptheria?), had normal titers to the protein (diptheria, or

whatever it is). Can anybody explain this very basic question about my own

daughter's dx that I never got any doc to explain before?

(mom to , age 6-1/2, dairy intolerant-related GERD -- currently

has polysaccharide antibody def, previously had transient IgG, IgA, t-cell &

other defs... and also to Kate, age 2-1/2, more dairy intolerant but very

healthy!)