Events during September 2023

Idiopathic Membranous Nephropathy: PLA2 and beyond

IIF and Artificial Intelligence

Food-induced immunotherapy has been practiced with varying success for over 100 years. Over the past 10 - 15 years it has gained a greater recognition in the potential management of children with food allergies. Food-induced immunotherapy can take the form of oral, epicutaneous or sublingual routes and usually results in a short-lived desensitisation rather than the acquisition of tolerance. For this reason, food immunotherapy is not a cure but relies on regular, usually daily, ingestion. Peanut immunotherapy lies mainly within the domain of clinic research however Palforzia (roasted peanut flour), was approved by NICE in February 2022 for the management of peanut allergy in children 4 to 17 years of age. The methodologies and factors associated with successful desensitisation to peanut will be discussed.

Vaccinations to Covid 19 virus have been at the forefront of news headlines. One of the issues highlighted was the risk of adverse reactions, both allergic and non-allergic. This caused an influx of queries to Allergy services regarding patients who had suffered potential allergic reactions and posed the question, 'how can they be investigated'?

The laboratory has limited commercial assays to the components and excipients of vaccines. However, tests can potentially be modified or developed in-house to provide evidence of a potential allergy. They could also be utilised to determine if an alternative vaccination can be used. The testing strategy may need to be adapted on a case by case basis.

There is the potential that this could be used to develop a service for allergic reaction investigation for all vaccine types.

Interpretation of ISAC

A person's immune response to previous antigen exposure is one of the most useful measures of how well their immune system is functioning. Vaccination provides a controlled and standardised exposure to an antigen, with the ability to assess immune responses prior to and after exposure. Different vaccine types can be used to explore different aspects of immune function.

Traditionally, antibody levels have been used to interrogate these responses, and it is possible to explore the quality of the antibody response and also cellular responses. A wide variability in the response to vaccination in healthy individuals can complicate interpretation of vaccine responses in patients with recurrent infections. Protection from infection is multifactorial, and while our ability to assess vaccine responses is improving, this alone is often not enough to assess an individual's immunity.

The analysis of free light chains in clinical laboratories to support the diagnosis and treatment monitoring of Myeloma has evolved over 6 decades. From urine analysis for Bence Jones Protein using gel electrophoresis in the 1950s to the launch of the first commercial assay for serum free light chain measurement in 2001.

This talk will describe the biochemistry of free light chains and the benefits and challenges of the different methodologies available in laboratories today. I will also describe the complexity of clinical interpretation of results, highlighting relevant national guidance, recently developed diagnostic tools for clinicians and testing advice for laboratories.

EQA of Autoimmunity

Immunology online Specialist Diploma programme

This presentation will cover a case study completed as part of the IBMS Specialist Diploma in Immunology in 2022. It will be of interest to anyone considering completing the Higher Specialist Diploma in Immunology, or anyone who would like to learn more about the case study element. It will also be of interest to anyone who would like to learn more about the protocols used for reading and reporting methods including immunophenotyping by flow cytometry, serum protein electrophoresis and immunotyping, serum free light chains and Bence Jones protein analysis at Greater Manchester Immunology Service (GMIS).

The case is one of an elderly gentleman with who, like roughly a third of new myeloma cases in the UK, presented through A&E. The presentation will cover pre-analysis, analysis and post-analysis, considering how the tests performed in the Immunology laboratory assist in the differential diagnosis and where they fit in with the other tests ordered, both tests within and outside of the Immunology discipline. The presentation will cover the methods performed at GMIS and some of the reporting protocols, as well as discussing some of the relevant associated guidelines.