The ability of patients with coeliac disease to produce primary and secondary antibody in response to a new antigen has been tested. Eight patients with coeliac disease were injected intravenously with the coliphage phiX 174. Antibody levels were measured throughout the primary response. On day 28 a second injection was given and the secondary response was also studied in detail. The production of antibody in the primary response is lower than in a group of normal subjects. The secondary response is severely reduced and the difference between the coeliac group and controls is highly significant. The secondary response in the coeliac patients contains a much higher proportion of IgM antibody than normal. These abnormalities correlate approximately with clinical status and with hyposplenism. It is concluded that in patients with coeliac disease the ability to produce antibody is impaired, with a defect in switching from IgM to IgG antibody.
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