Another subque'r in the house

So after a quick sinus CT this morning my husband met with an immunologist who had started lab work last month to recheck his response and levels.  She looked at the digital copy of the CT and said that other than some inflammation in the ethmoids he overall looked good (no maxillary problems). Then she went over the lab work that had been sent to Quest a month ago when he got his Prevnar shot and the lab work that was drawn last week to see if he responded.

His initial levels were 

IgG 975

IgA 263

IgM 17

The IgA number was a God send.  I was so glad to see that whatever problems he might have we wouldn't be fighting this monster too.  His IgM has always been low but this is the lowest yet.  (the IgG number I'll address later).

Then she started out by saying that he had absolutely no response to the Prevnar. NADA. ZIP. When he had these done in 2002 he at least responded to 2 or 3 of them.  Now nothing.  So she said he was not going to get anything for the IgM from infusions but she did think he would benefit from the antibody perspective.  Unfortunately that great IgG number meant nothing because it lacked any "brains". Also it will make it difficult to follow whether or not his dosage is therapeutic because we can't watch a number rise. He will be followed clinically and we will see if his symptoms improve.  She will run levels anyway in a month but will wait 3 months to see him again in the office.

On the Quest results there is a disclaimer paragraph that addresses what is considered a responder:

"Evaluation of the response to pneumococcal vaccination is best accomplished by comparing pre-vaccination and post-vaccination antibody levels.  A 2-to-4 fold increase in type specific antibodies measured 4-6 weeks after vaccination is expected in immunocompetent adults.  The number of serotypes for which a 2-to-4 fold increase is observed varies greatly among individuals; a consensus panel has suggested that individuals older than 5 years old should respond to at least approximately 70% of pneumococcal serotypes.  Adults >65 years old my exhibit a smaller (<2-fold) increase in type-specific antibody levels."

The reason I mention this is we were talking earlier this week about how many should respond to warrant medicine.  This opinion just happened to be on our paperwork today.

Also he had CD3, CD4, CD8 and CD19 levels done but I'm awful at interpreting these.  She didn't seem too concerned at the numbers. Sometime tomorrow I'll compare them to Macey's to see where he falls.

So they will submit the Hizentra prescription tomorrow and heaven only knows how much he's looking at infusing each week.