World Primary immunodeficiency Week: Let’s talk about PI!
Today, leading immune deficiency societies from every region of the world joined forces with patients, nurses and allied health professionals to launch the first World PI Week. This inaugural week will be celebrated from 22-29 April culminating in the World Day of Immunology on 29 April.
In support of the week, a dedicated Website has been created (www.worldpiweek.org) to serve as a catalyst and tool to support local stakeholders advocacy efforts throughout the week to raise awareness about primary immunodeficiences, drive the earliest possible diagnosis and ensure optimal treatment of this devastating group of diseases is available to every affected patient.
Primary Immunodeficiencies (PI) are hereditary and genetic defects in the immune system that cause increased susceptibility to a wide range of infections, affecting the skin, the ears, the lungs, the intestines and other parts of the body. These infections are often chronic, persistent, recurring, debilitating, and in some cases, fatal.
It is estimated that 10 million people suffer worldwide1. However, in Europe, Primary Immunodeficiencies are classified as rare diseases. Current diagnosis levels suggest that 1 in 8-10,000 people have a genetic primary immunodeficiency that significantly affects their health. However, experts estimate that between 70–90% of PI remain undiagnosed, and the true incidence of some PI within the general population could be as high as 1:250-500 [Prof. L. Notorangelo and Prof. L. Hammarstrom, STOA, European Parliament, March 2004]. These figures speaks for themselves and yet a simple and relatively inexpensive blood test CBC (Complete Blood Count) can identify over 95% of the patients! The problem remains one of lack of awareness leading to the majority of patients being diagnosed too late, with healthcare practitioners writing off these recurrent infections as ‘ just another cold’.
A recent peer-reviewed study documenting the financial impact associated with early diagnosis and management of PI in the USA found that each undiagnosed patient with an underlying PI costs the healthcare system an average of $102,552 (€75,587.40) annually, while after diagnosis and treatment costs to the healthcare system averaged $22,610 annually; yielding an average savings of $79,942 (€58,9223) per patient per annum2.
- Detecting the disease early can save lives and avoid unnecessary vaccinations that can cause serious illnesses and even death for undiagnosed PI patients.
- Detecting the disease early can save patients from lifelong disabilities like hearing loss or lung scarring.
- Detecting the disease early can significantly improve the patient’s quality of life, by reducing the usually numerous visits to the doctor and stays in hospitals. If treated early, the patient can get back to school or work.
- Detecting the disease early has huge benefits for the patients, their family and society as a whole During World PI Week (22-29 April) thousands of organisers across the globe will join forces and take these diseases out of the shadow, by encouraging governments to put in place targeted campaigns to increase recognition of PI amongst the medical profession, parents, schools, day care centres, and nurses.
The World PI Week Partners thank Baxter and CSL Behring for supporting this first World PI Week and hope to gain support from other companies to enable the initiative to continue and become self-sustaining.
About Primary Immunodeficiencies
What is a Primary Immunodeficiency Disease?
Nearly everyone has suffered from colds, the flu, or sinus and ear infections. Just as many have been affected by cuts, scrapes and abrasions that become infected. Even in the case of more severe infections - such as pneumonia - we expect the cough and congestion to 'run its course', aided by prescription antibiotics, over-the-counter symptom remedies, and our body's own immune system.
Recovery times vary, but the human body can usually rid itself of the infection-causing germs, and work to defend against future "bugs" and viruses. There are, however, instances in which the body cannot recover, and some of these apply to individuals with a primary immunodeficiency disease.
Primary immunodeficiency diseases occur in persons born with an immune system that is either absent or hampered in its ability to function. While not contagious, these diseases are caused by hereditary or genetic defects and can affect anyone, regardless of age or sex. The World Health Organization recognizes more than 150 primary immunodeficiency diseases - some are relatively common, others are quite rare. Some affect a single cell within the immune system; others may affect one or more components of the system.
And while the diseases may differ, they all share one common feature: each results from a defect in one of the functions of the body's normal immune system. Because one of the most important functions of the normal immune system is to protect us against infection, patients with primary immunodeficiency diseases commonly have an increased susceptibility to infection.
The infections may be in the skin, the sinuses, the throat, the ears, the lungs, the brain or spinal cord, or in the urinary or intestinal tracts, and the increased vulnerability to infection may include repeated infections, infections that won't clear up or unusually severe infections. People with primary immunodeficiency diseases live their entire lives more susceptible to infections--enduring recurrent health problems and often developing serious and debilitating illnesses. Fortunately, with proper medical care, many patients live full and independent lives.
Is it just an infection?
Do the same symptoms keep coming back or never seem to completely clear? Is the infection severe enough to require hospitalization or intravenous antibiotics? Is there a family history of early infant death or of susceptibility to infection?
If you answered yes to any of these questions it is critical to get an early diagnosis and proper medical care - don't hesitate to ask your physician to check for the possibility of a primary immunodeficiency disease.
Primary immunodeficiency disorders — also called primary immune disorders — weaken the immune system, allowing repeated infections and other health problems to occur more easily.
Many people with primary immunodeficiency are born missing some of the body's immune defenses, which leaves them more susceptible to germs that can cause infections.
Some forms of primary immunodeficiency are so mild they may go unnoticed for years. Other types of primary immunodeficiency are severe enough that they are discovered almost as soon as an affected baby is born.
In some cases, untreated primary immunodeficiency can lead to long-term health problems, including permanent damage to organs such as the ears or lungs, or physical disability.
One of the most common signs of primary immunodeficiency is an increased susceptibility to infections. You may have infections that are more frequent, longer lasting or harder to treat than are the infections of someone with a normal immune system. You may also get infections that a person with a healthy immune system wouldn't get (called opportunistic infections). However, signs and symptoms differ depending on the particular type of disorder you have, and signs and symptoms also vary from person to person.
Signs and symptoms of primary immunodeficiency can include:
- Frequent and recurrent ear infections, pneumonia, meningitis, bronchitis, sinus infections or skin infections
- Blood infections
- Inflammation and infection of internal organs, such as the liver
- Autoimmune disorders, such as lupus, arthritis or type 1 diabetes
- Blood disorders, such as low platelet counts or anemia
- Digestive problems, such as cramping, loss of appetite, nausea and diarrhea
- Delayed growth and development
When to see a doctor
If you or your child has frequent, recurrent or severe infections, or infections that don't respond to treatment, talk to your doctor. While primary immune deficiencies are rare, early diagnosis and treatment can prevent infections that can cause long-term problems.
Many primary immunodeficiency disorders are inherited — passed down from one or both parents. Faulty DNA — the genetic code that acts as a blueprint for producing the cells that make up the human body — causes many of the immune system defects in primary immunodeficiency. The faulty genes cause the immune system to develop problems.
Complications caused by a primary immunodeficiency disorder vary, depending on what particular disorder you have. They can include:
- Recurrent infections
- Autoimmune disorders
- Damage to heart, lungs, nervous system or digestive tract
- Slowed growth
- Increased risk of cancer
5. Preparing for your appointment
You're likely to start by first seeing your family doctor or a general practitioner. However, you may then be referred to a doctor who specializes in disorders of the immune system (immunologist).
Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Write down any symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Keep copies of records from hospitalizations and medical test results, including X-rays, blood test results and culture findings, and bring them with you to your appointment.
- Ask family members about the family medical history, including whether or not anyone was ever diagnosed with primary immunodeficiency, or if any babies or children died inexplicably in the past.
- Make a list of all medications, as well as any vitamins or supplements, that you or your child is taking. If possible, write down all of the antibiotic prescriptions and the dosage that you or your child have taken for the past several months.
- Ask a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
- What's the most likely cause of my or my child's symptoms?
- Are there other possible causes for these symptoms?
- What kinds of tests are needed to confirm the diagnosis? Do these tests require any special preparation?
- What's my or my child's prognosis?
- What treatments are available, and which do you recommend?
- What types of side effects can be expected from treatment?
- Are there any alternatives to the primary approach that you're suggesting?
- Are there any activity restrictions?
- Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
Preparing a list of questions ahead of time can help you make the most of the time with your or your child's doctor. For primary immunodeficiency, some basic questions to ask include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your or your child's doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you or your child first begin experiencing symptoms?
- Have these symptoms been continuous or occasional?
- How many infections have you or your child had during the past year?
- How long do these infections usually last?
- Do antibiotics usually clear up the infectious?
- Does anyone in your or your child's family have primary immunodeficiency?
6. Tests and diagnosis
To help decide whether recurrent infections could be due to primary immunodeficiency, your doctor will begin by asking a number of questions, such as what health problems you have, how long infections last, how severe they are and whether they respond to treatment. Your doctor will also want to know whether any close relatives have an inherited immune system disorder. Your doctor will perform a physical examination to look for clues that may indicate the cause of your illness. Primary immune disorders are rare, so your doctor will want to be sure your signs and symptoms aren't caused by a more common health problem.
There are several tests used to diagnose an immune disorder. They include:
- Blood tests. In most cases, blood tests can reveal abnormalities in the immune system that indicate an immune deficiency disorder. Tests can determine if you have normal levels of infection fighting proteins (immunoglobulin) in your blood. Tests can measure the levels of different blood cells and immune system cells. Abnormal numbers of certain cells can indicate an immune system defect. Other blood tests can determine if your immune system is responding properly and producing antibodies — proteins that identify and kill foreign invaders such as bacteria or viruses.
- Identifying infections. If you have an infection that's not responding to standard treatment, your doctor may do tests to try to identify exactly what germs are causing it.
- Prenatal testing. Parents who've already had a child with a primary immunodeficiency disorder may want to have testing done for certain immunodeficiency disorders during future pregnancies.
Samples of the amniotic fluid, blood or cells from the tissue that will become the placenta (chorion) are tested for abnormalities. In some cases, DNA testing is done to test for a genetic defect. Test results make it possible to prepare for treatment soon after birth, if necessary.
7. Treatments and drugs
Treatments for primary immunodeficiency involve preventing and treating infections, boosting the immune system and treating the underlying cause of the immune problem. In some cases, primary immune disorders are linked to a serious illness such as an autoimmune disorder or cancer that also needs to be treated.
- Antibiotics. Infections are typically treated with antibiotics. In cases where infections don't respond to standard medications, hospitalization and treatment with intravenous (IV) antibiotics may be necessary. Some people need to take antibiotics long-term to prevent infections from occurring and to prevent permanent damage to the lungs and ears.
- Treating symptoms. You may need medications to relieve symptoms caused by infections, such as ibuprofen for pain and fever, decongestants for sinus congestion, and expectorants to help clear your airways.
Treatment to boost the immune system
- Immunoglobulin therapy. Also called gamma globulin therapy, this treatment can be a lifesaver for people who have an antibody deficiency. Immunoglobulin consists of antibody proteins needed for the immune system to fight infections. It can be either injected into a vein through an IV line, or inserted underneath the skin (subcutaneous infusion). Treatment with intravenous gamma globulin is needed every few weeks to maintain sufficient levels of immunoglobulins. Subcutaneous infusion is needed once or twice a week.
- Gamma interferon therapy. Interferons are naturally occurring substances that fight viruses and stimulate immune system cells. Gamma interferon is a man-made (synthetic) substance given as an injection in the thigh or arm three times a week. It's used to treat chronic granulomatous disease, one form of primary immunodeficiency.
- Growth factors. When immune deficiency is caused by a lack of certain white blood cells, growth factor therapy — such as granulocyte-macrophage colony-stimulating factor (Leukine) and granulocyte colony-stimulating factor (Neupogen, Neulasta) — can help increase the levels of immune-strengthening white blood cells.
Treatment to cure primary immunodeficiency
- Stem cell transplantation. Stem cell transplantation offers a permanent cure for several forms of life-threatening immunodeficiency. With this treatment, normal stem cells are transferred to the person with immunodeficiency, giving them a normally functioning immune system. Stem cells can be harvested through bone marrow, or they can be obtained from the placenta at birth (cord blood banking).
- For stem cell transplantation to work, the donor — usually a parent or other close relative — must have body tissues that are a close biological match to those of the immunodeficient person. Stem cells that aren't a good match may be rejected by the immune system. But even with a good match, stem cell transplants don't always work. Additionally, the treatment often requires that any functioning immune cells be destroyed using chemotherapy or radiation prior to the transplants, leaving the transplant recipient even more vulnerable to infection temporarily.
- Gene therapy. Researchers hope this treatment will one day be a cure for primary immune disorders and many other conditions. Gene therapy actually replaces defective genes with genes that work correctly. A harmless virus is used to carry the genes into the body's cells. In turn, the newly introduced genes trigger the production of healthy immune system enzymes and proteins. Experts have identified many of the genes that cause primary immune deficiencies — but they still need to work out many problems. For example, some of the missing or defective genes are only activated during the early development of the immune system, so even if scientists can figure out how to get that gene where it needs to be, it would also have to trigger the development of the missing functions. Although the technique has shown promise in some initial trials, gene therapy is still experimental.
8. Coping and support
Because treatment options have improved, most people with primary immunodeficiency can go to school and work like everyone else. Still, you may feel as if no one understands what it's like to live with this chronic illness and the threat of serious infections. Talking to someone else who faces the same daily challenges may be helpful.
Ask your doctor if there are support groups in the area for people with primary immunodeficiency, or for parents of children with the disease. The Primary Immunodeficiency Resource Center of the Jeffrey Modell Foundation offers online message boards on its Web site where you can connect with others coping with primary immunodeficiency.
The Immune Deficiency Foundation (IDF) has a peer support program, as well as information on day-to-day living with primary immunodeficiency. For example, the IDF has a guide that you can download for school personnel so that they can better understand your child's condition.
Because primary immune disorders are caused by genetic defects, there's no way to prevent them. But when you or your child have a weakened immune system, you can take steps to prevent infections:
- Use proper hygiene. Wash your hands and skin with mild soap, and brush your teeth twice a day.
- Eat right. A healthy, balanced diet can help prevent infections.
- Avoid exposure. Stay away from people with colds or other infections and avoid crowds of people.
- Take your medications. You may need to take regular medications to prevent infection.
- Check with your doctor about which vaccinations you should have.