Differential decline in filaria-specific IgG1, IgG4, and IgE antibodies in Brugia malayi-infected patients after diethylcarbamazine chemotherapy.

In human filariasis, the predominant serum antibody is IgG4, accompanied by significant IgE production. The ratio of IgG4 to IgE is highest in asymptomatic microfilaremic carriers, while chronic disease is associated with elevated IgG1-3. The changes in isotypes following chemotherapy with diethylcarbamazine (DEC) were studied in 2 groups of Brugia malayi-infected patients from Sumatra and South Kalimantan, Indonesia. Similar results were obtained from each group. IgG4 levels decreased sharply (65%-78%) within 12 months. IgG1 levels declined in a less consistent and extreme manner, and levels of IgG2 and IgG3 declined only in patients with elephantiasis, who also had the highest initial levels of these antibodies. IgE responses were relatively stable to therapy in microfilaremic patients (7%-28% reduction) and showed only moderate decline (56% over 2 years) in elephantiasis patients. Active filarial infection is thus associated with specific IgG4 antibodies, but there is independent expression of the IgE and IgG4 isotypes in filariasis.