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The autoinflammatory diseases should be considered in the differential diagnosis of recurrent fever in childhood. These diseases are characterized by inflammatory episodes without an evident cause. Some of these diseases, like the Familial Mediterranean Fever, have a genetic origin and need a chronic treatment to avoid severe complications on the long term. PFAPA syndrome is the most frequent cause of recurrent fever and is diagnosed based on unspecific criteria. The treatment is still controversial. One dose of Prednisone is able to interrupt the flare and tonsillectomy may induce a remission in the majority of the cases.

The quantification of IgG anti-D subclasses is one of the most important parameters considered in the assessment of the severity of hemolytic disease of the newborn. Traditionally IgG subclassing is performed using qualitative haemagglutination methods, difficult to interpret. A quantitative enzyme-linked immunosorbent assay (Elisa) was implemented for measuring IgG anti-D subclasses in 20 sera collected from 14 RhD-immunized pregnant women. All 4 IgG subclasses were detected in the 20 sera tested. The mean proportion of IgG1 was 52.8%. The mean proportion of IgG3 was 30.7%. The mean proportions of IgG2 and IgG4 were 14.5 and 1.9% respectively. A good correlation between the sum of IgG subclasses and the severity of HDN was found. Severe HDN occurred when both IgG1 and IgG3 were present. IgG1 anti-D was the predominant subclass in 4 of the 8 severe cases.

Mucosal antibodies consist of a variety of molecules, including secretory IgA and local IgG, involved in the first immune barrier of defence against pathogens. They account for the majority of daily synthesized immunoglobulins in the body and mostly depend on the secretory immune system which is independent from its systemic counterpart. Acting by immune exclusion and immune elimination, these immunoglobulins correspond to preimmune poly-reactive natural antibodies and to antigen-induced antibodies. Recent progress in this field have suggested new approaches of mucosal vaccines preventing the entry of pathogens in the body.

Anti-D prophylaxis is currently applied in France after birth of an RhD positive infant, after interruption of pregnancy and after some antenatal immunizing events (amniocentesis...). However this program does not cover all the prenatal exposures to fetal RhD antigen, and maternal Rh immunization continues to occur. DNA RhD genotyping of the fetus is now reliably performed on amniotic fluid, and pre diagnostic studies on fetal DNA extracted from maternal plasma are promising. The widespread use of fetal RhD genotyping on maternal blood would allow the antenatal administration of Rh immunoglobuline in all Rh negative patients bearing an Rh positive fetus, insofar as it would preclude exposing the other Rh negative patients to the above plasma derived and rather expensive blood product.

In fetal liver, the stem cells of the B lineage transform into pre-B cells with intracytoplasmic mu-chains and thereafter into mature B cells with IgMc and IgMm. The other immunoglobulin classes appear later. The IgEm B cells appear on the day of birth. They bear IgMm and IgDm. Anti-IgM or anti-IgD suppression, performed from birth, prevents IgE synthesis. IgM and IgD seem to be necessary to IgE lymphocyte differentiation. Neonatal anti-IgE suppression seems to have no influence on IgE lymphocytes, but this result has to be confirmed. IgE immune responses are T-dependent. Neonatally thymectomized animals or rnu/rnu rats are unable to produce IgE immune responses. Axenic rats possess a great number of IgEm-IgAm-bearing cells in Peyer's patches; this is not observed in conventional animals. Nevertheless, the major problems are due to cells with receptors for IgE which must be differentiated from cells with intrinsic IgE. Work is under way to solve these problems.

We describe a sensitive liquid phase radioimmunoassay for serum IgD. Extreme values obtained from 85 control patients sera are 0.2 and 121 mg/l with an arithmetic mean of 25 mg/l. In atopic patients (with high serum IgE levels), arithmetic mean is 47 mg/l.