When you are getting sick all the time, you try to figure out why is this happening again and again, basically evaluating your Immune System. It is complex. Let me break it down for you into little bits. I would like to give you lots of information so when you decide to your practitioner, you would be able to intelligently talk about what tests you should be getting to try and figure out how your immune system is functioning.
We do not have great testing that looks at the function of your immune system. We have tests that look at different pieces of the immune system; tests that looks at the number of antibodies and the number of the cells. That can be useful, because if you have got an immune deficiency, we can see these change. They don’t give us a great idea about how well it functions.
To give you a good example, I used to work with HIV patients, and when you get HIV, one of the things that happens is your T cells drop, to the point where you get every opportunistic infection that comes along. I would see patients that had HIV, their T cell count was low compared to a normal healthy person. However, they never got sick, because the function of those cells was operating at such a high level that even though they had less cells, they were working better, and therefore they never got sick.
Keep that in mind because when we’re looking at these different parameters, we’re not always looking at how well they are functioning. Again, unfortunately we just haven’t evolved to a point yet where our testing gives us really good information about the function of your immune system. But nonetheless, I think these other blood tests can be very helpful to understand kind of what’s going on in your immune system.
One of the things I like to look at frequently as your immunoglobulin levels, and these are your antibodies. You’ve all heard about antibodies. These are the little things that your immune cells make that tell the rest of your immune system that, hey, there’s something here that doesn’t belong. So whether it’s a virus, bacteria, a parasite, antibodies’ jobs are basically to coat that so the other parts of the immune system can get involved and actually start to eradicate it from the body.
*There are different types of antibodies and they serve a different function.
**For our purpose today, we’re going to talk about really three of them.
***There are five of them, but the other two are not really related to fighting infection much.
A. IgA is immunoglobulin A, and IgA lines the mucous membranes of your body.
It’s in your nose, your throat, your intestinal tract, your bladder and its job is really to protect you against outside invaders. It’s really the first immunoglobulin or antibody to react when you get exposed to something that comes from the outside. We measure IgA levels as a marker of how well is that first line of defense in your immune system.
There’s a condition called selective IgA deficiency. It is the most inherited genetic immune deficiency. It is pretty common. For people who have this condition, often we find out exceedingly early in life because even as infants, these kids get chronic ear infections, they get gastrointestinal infections, they get bronchitis, they are sick quite a bit. There are variations of how this genetic condition gets expressed. You can make no IgA at all, or maybe you make a little bit. Depending on how much you make will dictate do you get sick a little or do you get sick a lot? This is a simple blood test that can be done (measures your IgA levels). You can find out if you have healthy normal levels or not.
B. The next antibody is called IgM or immunoglobulin M and IgM is your first line of defense once it gets past your mucous membrane.
It’s the first antibody to respond in an acute infection. IgM levels can start to go up within days, lasting several weeks after the exposure. Let us say you got strep throat. IgM levels would go up and then it would start to fight that. That molecule’s job is really the initial phase of recruiting other parts of your immune system to get involved to help get rid of the infection.
When we see IgM levels elevated in a blood test, it gives us a pretty good idea that either the exposure is acute, happened probably within a matter of weeks, or potentially it’s a reactivation of an old infection. We see this a lot with Lyme disease, where people can kind of come in and out of being IgM positive. It’s not always a sign that’s acute infection, but more often than not, it is. IgM again is a sign of more acute kind of infection.
C. Next, third immunoglobulin is IgG. IgG is really our long-term antibody.
It can take up to several weeks for IgG levels to be made. Those can last for months, sometimes years. if you’re an adult and you were exposed to Epstein-Barr virus when you were a teen, you will still have IgG antibodies to Epstein-Barr today because that virus is still in your body. IgG holds it at bay, keeps it from getting overgrown or allowing it to cause a problem. When we see IgG levels in the blood to any bacteria, virus, it’s just telling us that there’s been exposure before. If we see IgG positive, IgM negative, it may be an indication that this is an old infection or a past infection.
When I worked in the laboratory, I used to do this testing. And if we had someone come in, we would run IgG and IgM antibodies. We only run IgA antibodies if the infection is something that we can measure in the mucous membrane itself. We don’t do IgA testing much. Again, a lot of different pathogens that we test for. It’s usually IgG and IgM. If when we test, we find IgM is positive, IgG is negative, or the other way around, we measure again it two to four weeks later and check if it’s changed.
If they now are IgM negative IgG positive, it showed us is that they had that initial infection and now it’s moving out and it’s becoming a past infection. They have cleared it, the IgM went down. It’s not needed anymore. The IgG is persisting. At some point it may tail off completely and normalize or if it’s something you harbor your body on a normal ongoing basis, those IgG levels can stay persistent as well.
Those are the three antibodies we really use the most in measuring where your antibodies are functioning within your immune system.
D. There is a fourth antibody called IgE, immunoglobulin E.
I’ll mention it briefly only because we typically use this marker for allergies. Your body makes IgE antibodies to different allergens. If you’re trying to measure if you’re allergic to ragweed or dust, you will see IgE to ragweed or IgE to dust. However, certain types of parasitic infections will cause IgE to go up, too. An IgE that’s been elevated, isn’t always an allergy. If I see a high IgE in someone and they have really no allergy symptoms at all, it would make me very suspicious that they had an underlying parasitic infection. We need to investigate that.
We can also look at your T cells and B cells; think about your T cells as being your direct scavenger. They see bacteria, they see a virus, they go right after it, they munch it, they get rid of it. That is the end of that.
T cells are our most efficient immune molecules at clearing out the different pathogens when they invade us. –Tweet that!
B cells’ job is really to make those antibodies. B cells are what makes IgA, makes IgG, makes IgM –Tweet that!
There’s sort of a delay in the immune system that needs a second molecule to signal them to tell them to make antibodies. B cells receive a signal from other parts of the immune system saying, hey, there’s a problem over here. You need to take care of it. Then it starts making antibodies that are often very specific to strep, to Lyme, to Epstein-Barr, to whatever the pathogen is so that your body can start to clear it more efficiently.
Through a blood test, we can measure your different types of T cells and B cells. It is just measuring count; not measuring activity. If we see that there’s a frank deficiency in a certain type of cell, there might be things we can do to intervene to try and help support that part of the immune system. It’s called a T and B cell subset. That is the name of the blood test. If you’re concerned about that, you can talk with your doctor about running that blood test and seeing where your levels are.
There’s a very specific marker called CD57. We use this a lot for our Lyme patients CD57… that stands for clustered designation 57. When they started labeling different cells, they were trying to identify them, they had a system of doing that. All of these different immune cells have different CD markers, CD3, CD8, CD4. CD57 is specifically a natural killer cell marker and NK cells again are direct scavengers in our immune system. When our NK cell levels drop, our ability to fight those infections early on is a little bit compromised.
Certain types of T cells do that. We do get a little bit of overlap, but you can imagine working with half an army versus the full army isn’t going to be nearly as efficient. CD57 gives us a good idea about what your NK cell numbers look like. It doesn’t tell us about activity, but it does tell us about the numbers.
There’s also another part of our immune system that most people really don’t ever talk about, or maybe haven’t heard of It’s called complement and not compliment like, hey, that’s a really nice dress you’re wearing today. This is C-O-M-P-L-E-M-E-N-T. It’s with an E instead, not an I. Complement with an E is referring to different parts of the immune system.
What happens is your body makes antibodies. Those antibodies coat the bacteria we want to get rid of. Then the complement attaches to the antibody and literally starts poking holes into the bacteria. It’s like punching a bunch of holes in a balloon that’s filled. Eventually it pops, it bursts, and it dies. That’s the end of that. So complements really the finale of our immune system, being able to get rid of different pathogens. There are different types of complement. We typically measure what’s called C3 and C4.
These are simply different levels of complement. What we should see is that those levels are high. When we start to see extremely low levels of complement, it can be an indication that either they’re being used. If you have like an autoimmune condition that’s constantly calling for complement, those levels will drop. But again, there can be other types of conditions where you’ve got an abnormally low level of complement, which means that that last part of the immune system just isn’t functioning nearly as well as it could. And again, these are all done through blood tests.
If you are concerned that you’ve got an immune problem, you’re getting sick all the time, you’re trying to figure it out; talk to your doctor or healthcare provider about running these pretty simple blood tests. Insurance typically pays if you’ve got evidence of immune deficiency, and you can have that discussion with them and run them and just make sure that there’s nothing else in the immune system that might be contributing to why you don’t feel so well.
I hope you found these videos helpful.
Dr. Darin Ingels
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- 1 A. IgA is immunoglobulin A, and IgA lines the mucous membranes of your body.
- 2 B. The next antibody is called IgM or immunoglobulin M and IgM is your first line of defense once it gets past your mucous membrane.
- 3 C. Next, third immunoglobulin is IgG. IgG is really our long-term antibody.
- 4 D. There is a fourth antibody called IgE, immunoglobulin E.
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