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Answer 4
  1. Serum antibodies to tetanus toxoid and pneumococcal antigens. Patients with specific antibody deficiency frequently present with recurrent sinopulmonary infection with bacteria. Despite normal levels of total IgG, IgA, or IgM, patients with this deficiency are unable to produce antibodies to specific antigens (specific antibodies or functional antibodies). Evaluation of functional antibody production in patients who have received childhood immunizations should include measurement of serum antibodies to protein antigens (tetanus toxoid, diphtheria toxoid) and carbohydrate antigens (isohemagglutinins, pneumococcal polysaccharide antigens). Evaluation of antibody response to carbohydrate antigens should be performed using unconjugated pneumococcal vaccine (23-valent) since protein-conjugated polysaccharide antigens are recognized and processed by a subset of B cells that respond to protein antigens and they are different from the ones that respond to carbohydrate antigens.

     Bonilla FA, Geha RS. 12. Primary immunodeficiency diseases [published erratum appears in J Allergy Clin Immunol 2003;112:267]. J Allergy Clin Immunol 2003;111(2 Suppl):S571-81.

    2. Mouthon L, Lortholary O. Intravenous immunoglobulins in infectious diseases: where do we stand? Clin Microbiol Infect 2003;9:333-8.

    3. Tangsinmankong N, Bahna SL, Good RA. The immunologic workup of the child suspected of immunodeficiency. Ann Allergy Asthma Immunol 2001;87:362-9.

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