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

• Published in: Journal of clinical immunology 2019-02, Vol.39 (2), p.216-224
• Main Authors: Zysman-Colman, Zofia N., Kaspy, Kimberley R., Alizadehfar, Reza, NyKamp, Keith R., Zariwala, Maimoona A., Knowles, Michael R., Vinh, Donald C., Shapiro, Adam J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biomedical and Life Sciences; Biomedicine; Chemiluminescence; Child; Ciliary Motility Disorders - diagnosis; Ciliary Motility Disorders - metabolism; Cough; Diagnosis, Differential; Female; Humans; Immunodeficiency; Immunology; Infectious Diseases; Internal Medicine; Male; Medical Microbiology; Middle Aged; Neonates; Nitric oxide; Nitric Oxide - metabolism; Nose; Original Article; Premature birth; Primary ciliary dyskinesia; Primary immunodeficiencies; Primary Immunodeficiency Diseases - diagnosis; Primary Immunodeficiency Diseases - metabolism; Respiratory tract diseases; Young Adult
• ISSN: 0271-9142; 1573-2592
• DOI: 10.1007/s10875-019-00613-8

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