title: Salivary Immunoglobulin A (IgA) in children with IgA vasculitis
Creators: name: Alomairi, Maryam
Publisher: name: University of Liverpool Repository
Year: 2024

description: Abstract 
 
Introduction: 
The local salivary immunoglobulin A (IgA) is the predominant immunoglobulin in the saliva and plays an 
important role in the local immune defence system. It is believed that an abnormal production of IgA 
can cause systemic inflammatory diseases such as IgA vasculitis and IgA nephropathy. First and 
foremost, IgA vasculitis is the most common form of childhood vasculitis which is characterized by a 
skin rash and a classical triad of symptoms involving the gastrointestinal system, musculoskeletal and 
renal system which is not always present. The incidence of IgA related disease is increasing across the 
world and it is a leading cause of chronic kidney disease. It should be noted that previous literature has 
demonstrated that poor oral hygiene may trigger IgA production and some studies have shown that 
children affected by IgA vasculitis are highly likely to suffer from dental caries pulp infection /
inflammation, periapical infections and periodontal disease. 
Aim: 
The aim of the project is to determine whether children with IgAV have an increased production of 
salivary IgA by exploring the existing literature, piloting saliva collection methods, and validating the 
analytic performance of an assay to quantify salivary IgA as a potential biomarker for IgA induced 
vasculitis.
 
Methods: 
This study was cross-sectional pilot study. Children were recruited from Alder Hey Children's NHS 
Foundation Trust Hospital. The target populations were three groups of children, the first group of 
children were those with a diagnosis of immunoglobulin A vasculitis (IgAV) who attended Alder Hey 
Children's NHS Foundation Trust Hospital for renal monitoring. The second group of children were 
termed a dental control group which was children who were attending the clinic at the paediatric dental 
department, Alder Hey Children’s Hospital. The third group of children were classed as a healthy control
cohort. Patients were recruited as part of the IgA vasculitis (IgAV) study during their routine clinical 
follow up visitsfor regular kidney check-ups. A data collection sheet were used to collect data regarding 
the disease activity and oral health status using specific dental scoring tools. The Child Oral Health 
Impact Profile (COHIP) Questionnaire were completed and used in this study. The saliva samples were 
collected by either salivabio passive drool method or forced method. Saliva samples were centrifuged
for 10 minutes at 800 g to remove any cells or debris and then the sample was isolated, stored and 
frozen at -80 degrees Celsius in 200 microL aliquots. Finally, IgA immunoglobulin was extracted and 
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quantified using Enzyme Linked Immunosorbent Assay (ELISA) assays. Initially healthy adult control 
samples were used to optimize the experiments. The study had full ethical approval. 
Results: 
A total of 15 children were recruited in this study. Of these, 5 patients had a diagnosis of IgAV, 5 
children had a diagnosis of dental and oral issues, and the remaining 5 children were recruited as 
healthy controls. From this cohort, 10 (66.67%) of them were males and 5 (33.33%) were females. 
The median age of the first group which is the healthy cohort was 7 years, for the second group which 
is the IgAV the median was 8 years and for the third cohort which was patient with oral and dental 
caries the median age was 11 years. In the first group, the healthy control, the youngest participant 
was five years old and the eldest was eleven. In the IgAV cohort, the youngest child was six years old 
and the eldest was twelve. In the third group, which consisted of patients with oral and dental issues, 
the youngest participant was 8 years old and the eldest was 12 years old. The age range of the 15 
children was 7 years. The concentration values of 108.1075, 55.2175, and 75.49 were recorded for 
the dental group, healthy group, and IgAV group, respectively. There was no significant differences 
were observed between the three groups. 
Furthermore, there was no statistically significant difference in the levels of IgA between the forced 
and passive samples which was taken from adult control to optimise the different methods to collect 
saliva.
Regarding the Child Oral Health Impact Profile Questionnaire (COHIP) given to adult controls, three 
participants found it very good (37.5%), while one thought it was fair (12.5%). In terms of overall 
rating, three participants rated it very good, while one rated it poor. To make it easier for children, we 
provided a Modified Oral Health Questionnaire for the dental group. Out of five participants, two 
rated their dental health as 7, one as 9, one as 8, and one as 5. Overall, the questionnaire received an 
average rating of 7.2 out of 10, which is generally considered good based on the collected responses.
Conclusion: 
This pilot study was not able to demonstrate any difference in the IgA concentrations in children with 
IgAV compared to children who had oral and dental concerns or healthy controls. Several factors 
could contribute to this outcome, that include the study limitations such as the small sample sizes. 
Further studies are required to explore the role of salivary IgA in this inflammatory disease.