The diagnosis of hereditary angioedema with C1 inhibitor deficiency: a survey of Canadian physicians and laboratories.

BACKGROUND: Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) is an autosomal dominant disease resulting in random and unpredictable attacks of swelling. The swelling in C1-INH-HAE is a result of impaired regulation of bradykinin production. The fact that the array of tests needed to diagnose HAE is not always available to the treating physicians is challenging for them and their patients. METHODS: The data for this article were extracted from two distinct surveys. The first survey was conducted among HAE treating physicians and aimed to determine the availability and utilization of the various assays performed to help the diagnosis of C1-INH-HAE. The second survey was conducted with the various laboratories across Canada that performs the assays used in the diagnosis of HAE. The aim of this survey was to determine the availability and profile of the various assays used in the diagnosis of C1-INH-HAE in Canada, thereby ultimately bringing a rational basis for the biological testing. RESULTS: C1-INH functional assay was widely available in Canada (93%), but was only offered by a small numbers of hospitals meaning that there could be longer delays in the analysis of these samples that may explain why the physicians expressed a lower level of confidence in this assay (59%). Antigenic C1-INH was available to the vast majority of the physicians treating C1-INH-HAE (93%) and was considered reliable by 96% of the respondents. Antigenic C4 was found available to all Canadian physicians and, although with limited specificity, was considered very reliable by all the participants. This study revealed that 81% of physicians were able to order the antigenic C1q and the confidence in this assay was moderate (70%). Concerning genetic testing, the survey revealed that most of the CHAEN members never had to or couldn't order this test. CONCLUSION: This study highlights the need for improved education and knowledge exchange, about biological assays available to Canadian physicians and their performance in proper diagnosis of C1-INH-HAE to improve confidence and access to relevant tests.

Stimulation of anti-polio and anti-HSV IgA pre-plasma cell response in blood following parenteral immunization with tetanus-diphtheria vaccine.

Systemic immunization can elicit a significant response of IgG producing activated B cell subsets in human blood, part of which is not toward the vaccine. However, the effect of vaccination on IgA antibody secreting B cell subsets has had limited investigation. We immunized healthy, adult volunteers with a tetanus/diphtheria vaccine and observed a significant burst of IgA-secreting pre-plasma cells (PPC). Isolated PPC produced IgG, but not IgA antibody to tetanus antigen, and produced IgA and IgG antibody specific for poliovirus and herpes simplex virus. Thus, a vaccine that generates a systemic recall response to tetanus also induces blood PPC secreting IgA and IgG antibody relevant to mucosal protection.