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    Transiently increased IgE responses in infants and pre-schoolers receiving only acellular Diphtheria–Pertussis–Tetanus (DTaP) vaccines compared to those initially receiving at least one dose of cellular vaccine (DTwP) – Immunological curiosity or canary in the mine?

    Access Status
    Fulltext not available
    Authors
    Holt, P.
    Snelling, Thomas
    White, O.
    Sly, P.
    DeKlerk, N.
    Carapetis, J.
    Biggelaar, A.
    Wood, N.
    McIntyre, P.
    Gold, M.
    Date
    2016
    Type
    Journal Article
    
    Metadata
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    Citation
    Holt, P. and Snelling, T. and White, O. and Sly, P. and DeKlerk, N. and Carapetis, J. and Biggelaar, A. et al. 2016. Transiently increased IgE responses in infants and pre-schoolers receiving only acellular Diphtheria–Pertussis–Tetanus (DTaP) vaccines compared to those initially receiving at least one dose of cellular vaccine (DTwP) – Immunological curiosity or canary in the mine?. Vaccine. 34 (35): pp. 4257-4262.
    Source Title
    Vaccine
    DOI
    10.1016/j.vaccine.2016.05.048
    ISSN
    0264-410X
    School
    School of Public Health
    URI
    http://hdl.handle.net/20.500.11937/55337
    Collection
    • Curtin Research Publications
    Abstract

    © 2016 Elsevier Ltd Background Several previous studies have highlighted the strong Th2-polarising and IgE-promoting activity of the DTaP vaccine, but there is no evidence that this has pathological consequences and accordingly there is no current interest amongst vaccine developers in reformulating DTaP to attenuate these properties. In light of an apparent resurgence in pertussis in many countries, and emerging evidence from other areas of paediatric immunology of IgE-mediated interference with host defence mechanisms, this issue requires more detailed clarification. Methods We have re-evaluated the impact of DTaP-only versus mixed DTwP/DTaP vaccination on Th2-dependent “bystander” IgE responses in three cohorts of children under different priming conditions, encompassing both vaccine-targeted and unrelated antigens including food allergens. Results We confirm the generalised IgE-trophic activity of the DTaP vaccine in pre-schoolers and demonstrate similar (albeit transient) effects in infants. We additionally demonstrate that use of an alternative mixed infant priming schedule encompassing an initial dose of DTwP significantly attenuates this property. Interpretation Central to our interpretation of these findings are studies demonstrating: (i) mixed DTwP/DTaP priming improves resistance to pertussis disease and attenuates the IgE-stimulatory component of long term vaccine-specific memory; (ii) IgE-mediated mechanisms can interfere with innate antiviral immunity and accordingly exacerbate airway symptoms in infected children. These observations, taken together with the data presented here, suggest a plausible mechanistic link between baseline pertussis-specific IgE titres in DTaP vaccinees and susceptibility to pertussis disease, which merits testing. Retrospective IgE analyses on sera collected from children at the time of presentation with pertussis could resolve this issue.

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