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J Clin Immunol. 2019 Feb;39(2):216-224. doi: 10.1007/s10875-019-00613-8. Epub 2019 Mar 26.

Nasal Nitric Oxide in Primary Immunodeficiency and Primary Ciliary Dyskinesia: Helping to Distinguish Between Clinically Similar Diseases.

Author information

1
CHU Sainte-Justine, 3175 Chemin de la Cote-Ste-Catherine, Montreal, Quebec, H3T1C5, Canada.
2
Montreal Children's Hospital, McGill University Health Center, 1001 Boulevard Décarie, Montreal, Quebec, H4A 3J1, Canada.
3
McGill University Health Center Research Institute, 1001 Boulevard Décarie, Montreal, Quebec, H4A 3J1, Canada.
4
Invitae, San Franscisco, CA, USA.
5
Department of Pathology and Laboratory Medicine, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, CA, USA.
6
Department of Medicine, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, CA, USA.
7
Montreal Children's Hospital, McGill University Health Center, 1001 Boulevard Décarie, Montreal, Quebec, H4A 3J1, Canada. adam.shapiro@muhc.mcgill.ca.
8
McGill University Health Center Research Institute, 1001 Boulevard Décarie, Montreal, Quebec, H4A 3J1, Canada. adam.shapiro@muhc.mcgill.ca.

Abstract

PURPOSE:

Primary ciliary dyskinesia (PCD) is a rare disorder of the mucociliary clearance leading to recurrent upper and lower respiratory tract infections. PCD is difficult to clinically distinguish from other entities leading to recurrent oto-sino-pulmonary infections, including primary immunodeficiency (PID). Nasal nitric oxide (nNO) is a sensitive and specific diagnostic test for PCD, but it has not been thoroughly examined in PID. Past publications have suggested an overlap in nNO levels among subjects with PCD and PID. We sought to determine if nNO measurements among patients diagnosed with PID would fall significantly above the established PCD diagnostic cutoff value of 77 nL/min.

METHODS:

Children > 5 years old and adults with definitive PID or PCD diagnoses were recruited from outpatient subspecialty clinics. Participants underwent nNO testing by standardized protocol using a chemiluminescence analyzer and completed a questionnaire concerning their chronic oto-sino-pulmonary symptoms, including key clinical criteria specific to diagnosed PCD (neonatal respiratory distress at term birth, year-round cough or nasal congestion starting before 6 months of age, any organ laterality defect).

RESULTS:

Participants included 32 patients with PID, 27 patients with PCD, and 19 healthy controls. Median nNO was 228.9.1 nL/min in the PID group, 19.7 nL/min in the PCD group, and 269.4 in the healthy controls (p < 0.0001). Subjects with PCD were significantly more likely to report key clinical criteria specific to PCD, but approximately 25% of PID subjects also reported at least 1 of these key clinical criteria (mainly year-round cough or nasal congestion).

CONCLUSIONS:

While key clinical criteria associated with PCD often overlap with the symptoms reported in PID, nNO measurement by chemiluminescence technology allows for effective discrimination between PID and PCD.

KEYWORDS:

Primary ciliary dyskinesia; nasal nitric oxide; primary immunodeficiency

PMID:
30911954
DOI:
10.1007/s10875-019-00613-8

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