High Serum IgE Levels Research Articles

Factors associated with recurrent hospitalizations in asthmatic children

Objective. – To determine preventable risk factors associated with recurrent hospitalization of children for acute asthma attacks. Methods. – A retrospective analysis of 288 asthmatic children between 6 and 15 years of age who were hospitalized between 31 December 1993 and 1 January 2000 was carried out. Results. – Admissions for asthma were higher in boys than in girls (male to female ratio 1.8). Of 288 children, 68 (23.6%) had multiple admissions, defined as a more than one admission per year during the follow-up period. The following factors were associated significantly with recurrent hospital admissions for asthma attacks: maternal smoking ( P < 0.02); frequent upper respiratory tract infection ( P < 0.001); high levels of total serum IgE ( P < 0.02); high peripheral blood eosinophil count ( P < 0.001); atopic dermatitis ( P < 0.001); and age less than 11 years ( P < 0.05). Using multivariate logistic regression analysis, among others factors only maternal smoking ( r = 0.24, P < 0.001) and frequent upper respiratory tract infection ( r = 0.37, P < 0.001) were significant factors for recurrent admissions. Conclusion. – Prevention of maternal smoking and frequent upper respiratory tract infections may be effective in decreasing re-admission to hospital in asthmatic children.

From IgE to anti-IgE: where do we stand?

From IgE to anti-IgE: where do we stand?

Enhanced expression of B7.2 (CD86) by percutaneous sensitization with house dust mite antigen

House dust mite antigen is a well-known allergen in the pathogenesis of atopic dermatitis (AD), a chronic relapsing inflammatory skin disease. We evaluated the AD model mice sensitized with house dust mite antigen and observed a Th2-dominant immune response. In this experiment, BALB/c mice were sensitized percutaneously with house dust mite antigen three times with 7 days interval after skin barrier disruption. A remarkable infiltration of polymorphonuclear granulocytes and monocytes in the cutis was observed in mice treated with this antigen, high serum IgE levels and IL-4 mRNA expression in local lymph node cells was also observed. CD19 + B cell numbers overturned to CD4 + helper T cells. In these mice, there was significant increase of B7.2 (CD86) expression on CD19 + B cells. These results indicate that house dust mite antigen sensitizes BALB/c mice and skews their Th1/Th2 balance toward Th2.

Clinical and immunologic factors associated with the presence or absence of airways hyper-responsiveness in childhood asthma.

During the baseline period of a clinical trial comparing different dosage schedules of inhaled steroids, asthmatic children (aged 6-10 years) were expected to meet the inclusion criterion of airways hyper-responsiveness (PD(20) methacholine < 80 micro g) after withdrawal of inhaled corticosteroids for 2-8 weeks. However, many children failed to do so. It has been shown that young wheezing children may outgrow their symptoms. We investigated if differences between children with and without airways hyper-responsiveness after withdrawal of inhaled corticosteroids were compatible with differences between transient and persistent wheezers found in other studies. Seventy-eight children entered the study, of which 41 developed airways hyper- responsiveness after withdrawal of inhaled corticosteroids, and 37 did not. These two groups of children were compared with respect to differences in demographic, clinical, and immunological features (IL-4, IL-5, IL-10, and IFN-gamma produced by Con A stimulated peripheral mononuclear cells (PBMCs) and serum IL-4, IL-5 and soluble intercellular adhesion molecule-1 (sICAM-1)). Hyper-responsive children had more atopic features (positive RAST, high IgE, eczema), lower levels of FEV1 and lower concentrations of sICAM-1 than non-hyper-responsive children. Apart from a borderline significantly higher IL-4 production in the hyper-responsive group, other immunologic parameters were comparable. Multivariate logistic regression analysis showed that high serum IgE, low FEV1, and low sICAM-1 levels were independently associated with the presence of airways hyper-responsiveness after stopping inhaled corticosteroids. Atopy was associated with higher concentrations of IL-4 in the hyper-responsive group. After withdrawal of inhaled corticosteroids many children previously diagnosed with asthma did not develop airways hyper-responsiveness. We conclude that hyper-responsive children share features with persistent wheezers as found in previous studies, whereas the non-hyper- responsive children may represent transient wheezers.

Low molecular weight PTP-IL-4RA interaction in atopy predisposition.

We recently described a protective effect of the low molecular weight protein tyrosine phosphatase (LMPTP) BC genotype, associated with the highest total enzymatic activity, against high serum IgE levels both in the English and the Italian populations. Here we test the hypothesis of a role of LMPTP in the negative modulation of IL-4 signal transduction checking for genetic interaction between interleukin-4 receptor alpha chain (IL-4RA) genetic polymorphisms and LMPTP polymorphism in the predisposition to high total IgE levels in the English population. We find a significant interaction between LMPTP polymorphism and the intracellular Gln/Arg polymorphism in position 551 of IL-4RA. Our data support the hypothesis of a direct or indirect biochemical interaction between LMPTP and IL-4RA resulting in different modulation of IL-4 signal transduction among joint genotypes.

Regulatory effects of novel neurotrophin-1/b cell-stimulating factor-3 (cardiotrophin-like cytokine) on B cell function.

We describe regulatory effects that a novel neurotrophin-1/B cell-stimulating factor-3 (NNT-1/BSF-3; also reported as cardiotrophin-like cytokine) has on B cell function. NNT-1/BSF-3 stimulates B cell proliferation and Ig production in vitro. NNT-1/BSF-3-transgenic mice, engineered to express NNT-1/BSF-3 in the liver under control of the apolipoprotein E promoter, show B cell hyperplasia with particular expansion of the mature follicular B cell subset in the spleen and the prominent presence of plasma cells. NNT-1/BSF-3-transgenic mice show high serum levels of IgM, IgE, IgG2b, IgG3, anti-dsDNA Abs, and serum amyloid A. NNT-1/BSF-3-transgenic mice also show non-amyloid mesangial deposits that contain IgM, IgG, and C3 and are characterized by a distinctive ultrastructure similar to that of immunotactoid glomerulopathy. NNT-1/BSF-3-transgenic mice produce high amounts of Ag-specific IgM, IgA, and IgE and low amounts of IgG2a and IgG3. Normal mice treated with NNT-1/BSF-3 also produce high amounts of Ag-specific IgE. NNT-1/BSF-3 regulates immunity by stimulating B cell function and Ab production, with preference for Th2 over Th1 Ig types.

Predominant expression of 950delCAG of IL-18R α chain cDNA is associated with reduced IFN-γ production and high serum IgE levels in atopic Japanese children

Background: We previously reported that serum IgE levels were negatively correlated with the amount of IFN-γ produced by phytohemagglutinin-stimulated or IL-12-stimulated PBMCs and that one of the mechanisms of the pathogenesis of atopy was the reduced IFN-γ production, which led to upregulated IgE production. Objective: IL-18 is also known to be a strong inducer of IFN-γ production. However, it has not yet been determined whether IL-18 is associated with atopic disease. Methods: We investigated the response to IL-18 or IL-12 stimulation and the sequence of IL-18 receptor (IL-18R) α chain cDNA in 41 nonatopic controls and 39 atopic patients. Results: Serum IgE level was negatively correlated with IFN-γ production by PBMCs stimulated with IL-18. The IL-18R α chain cDNA of atopic patients was sequenced. We identified a 3-base deletion of the IL-18R α chain cDNA (950delCAG ), which was generated by alternative splicing, as determined on the basis of genomic sequence data for the IL-18R α chain gene. PBMCs with the predominant expression of 950delCAG significantly showed the reduced IFN-γ production after IL-18 stimulation. There was a significant difference in the expression pattern of the IL-18R α chain transcript between the atopic patients and the nonatopic controls. Conclusion: According to these results, the dominant expression of the 950delCAG transcript of IL-18R α chain cDNA, which was associated with reduced IFN-γ production by IL-18 stimulation and high serum IgE levels, is predisposition to some atopic diseases. (J Allergy Clin Immunol 2002;109:669-75.)

More Than 13 Years of Hypereosinophila Associated With Clonal CD3−CD4+ Lymphocytosis Of TH2/TH0 Type

A 65-year-old Japanese woman was referred to our hospital because of hypereosinophilia lasting for more than 10 years, and skin ulceration, especially on the hands. Closer examination revealed the clonal proliferation of CD3-CD4+T-lymphocytes. The patient had generalized pruritus without severe end-organ involvement and high serum levels of IgE. A diagnosis of monoclonal CD3-CD4+ T-lymphocyte-associated idiopathic hypereosinophilic syndrome (HES) was made based on these findings. This case showed that this newly recognized entity of HES is not restricted to Western countries. The abnormal T-cell clone was not merely TH2 type but was clearly TH2/TH0 type. Although this disease is considered prelymphoma, this patient did not develop lymphoma during more than 13 years of follow-up. Therefore, in some patients, clonal CD3-CD4+ lymphocyte-associated HES may take a more indolent course. In this subgroup, the control of clinical manifestations seems very important. In the present case, treatment with hydroxyurea quite dramatically improved the intractable skin manifestations, although the treatment lessened only the number of peripheral eosinophils and not the number of clonal CD3-CD4+ T-lymphocytes.

Increase in serum IgE levels following injection of syngeneic keratinocyte extracts in BALB/c mice.

Increased serum IgE levels are found in atopic diseases, especially atopic dermatitis. It is generally accepted that the high serum IgE levels are increased by exposure to exogenous antigens. However, exposure to antigens in the absence of proper adjuvants does not usually increase serum IgE. Here, we studied the involvement of skin factor(s) in increasing serum IgE. The soluble fractions were obtained from two keratinocyte cell lines, PAM 212 and KCMH-1, derived from BALB/c and CBA/J mice, respectively. These were injected subcutaneously into parental mice strains at 2-week intervals. The levels of serum immunoglobulins and the release of IgE in vitro from spleen cells were measured by ELISA. The biological activity of the increased serum IgE was assessed by sensitization of RBL-2H3 mast cells with serum. Six injections of PAM 212-derived fraction (PAM extract) consistently increased the serum levels of IgE, IgG1 and IgG2b, but not those of IgM, IgG2a, IgG3 or IgA in BALB/c mice. The high serum levels of IgE were sustained for at least 10 weeks after one or two injections of PAM extract. When RBL-2H3 cells were sensitized with the serum from mice injected with PAM extract, they released histamine in response to anti-IgE. Moreover, spleen cells of these mice produced significantly higher amounts of IgE than those of uninjected mice in the presence of IL-4 and anti-CD40 antibody. On the other hand, no significant increase in immunoglobulins was observed following injection of the soluble fraction from KCMH-1 cells in CBA/J mice. These results suggest that the release of the soluble fraction of keratinocytes and its exposure to immunologically competent cells may induce an increase in serum IgE levels by a Th2-dominant mechanism.

Genome-wide search for atopy susceptibility genes in Dutch families with asthma

Background:Atopy is a phenotype associated with asthma that has a heritable component. However, the role of atopysusceptibility genes in the development and expression of asthma and allergic disorders is not understood. Objective: We sought to study the familial aggregation and co-occurrence of atopic phenotypes within family members of patients with asthma and to identify chromosomal regions that may contain genes that regulate different atopic phenotypes. Methods: In 200 families (n = 1174) ascertained through a proband with asthma, genome-wide screen and linkage analysis was performed for the following atopic phenotypes: (1) specific IgE to common aeroallergens (Phadiatop assay); (2) specific IgE to Der p 1; (3) positive skin test responses to house dust mite; (4) positive skin test responses to 1 or more of 16 allergens; and (5) peripheral blood eosinophils. Results were compared with the linkage results for total serum IgE levels. Results: There was clear familial aggregation of atopy. A high total serum IgE level in combination with a positive Phadiatop result or a normal total IgE level in combination with a negative Phadiatop result was found in 56.1% of the probands and 66.9% of the offspring. Several chromosomal regions that showed evidence for linkage to an atopic phenotype (ie, 2q, 6p, 7q, and 13q) also showed evidence of linkage with total serum IgE (Xu et al. Am J Hum Genet 2000;67:1163-73). Specific regions of interest for atopic traits were also detected on chromosomes 11q, 17q, and 22q. Conclusions: Atopic phenotypes show familial aggregation, although family members may differ in expression of atopy. Specific chromosomal regions appear to be important in susceptibility to different phenotypes of atopic responsiveness. (J Allergy Clin Immunol 2002;109:498-506.)

Overactivation of IL-4-induced activator protein-1 in atopic dermatitis

Atopic dermatitis is regarded as mediated by Th2-type immunity. In fact, it frequently coincides with the elevation of immunoglobulin (Ig)-E in patients’ sera. Due to the pivotal role of interleukin (IL)-4 in regulation of IgE, we hypothesized if atopic dermatitis represents a hyper-reactive condition in response to IL-4 when it coincides the higher serum level of IgE. To address this possibility, peripheral blood mononuclear cells (PBMC) isolated from patients with atopic dermatitis with the high serum IgE level, from those with psoriasis or from healthy volunteers were stimulated with recombinant IL-4 and analyzed for activation of transcription factors including activator protein (AP)-1 or signal transducers and activators of transcription (STAT)-6 by employing electrophoretic mobility shift assays. Although no significant difference between atopy patients and other groups was observed in the STAT-6 binding activity in IL-4-stimulated PBMC, it over-activated the binding of AP-1 in PBMC of the patients with atopic dermatitis. The AP-1 binding was interfered by the use of an antibody directed against JunB. This is the indication that IL-4-overactivated AP-1 is composed of JunB. Furthermore, semi-quantitative RT-PCR analyses revealed marked down-modulation of a Th1 cytokine, interferon (IFN)-γ, in IL-4-stimulated PBMC derived from atopy patients, but not that from healthy individuals. Together, our present study indicates that AP-1 is over-activated by IL-4 in PBMC of the atopic patients with the higher IgE level, thereby implying that IL-4-induced over-activation of AP-1 might be one of pathogenic factors in atopic dermatitis.

Inhibitory effects of local allergen pretreatment on systemic allergen sensitization depends on the presence of lipopolysaccharides (LPS) in a murine model of allergic airway inflammation

Inhibitory effects of local allergen pretreatment on systemic allergen sensitization depends on the presence of lipopolysaccharides (LPS) in a murine model of allergic airway inflammation

顎下腺に生じた線維素性唾液管炎の1例

A case of sialodochitis fibrinosa of the submandibular glands is reported. A 40-year-old woman consulted us with a complaint of recurrent swelling of bilateral submandibular glands for 5 years. Bilateral submandibular glands were diffusely swollen and elastic-firm. Orifices of ducts were also diffusely swollen. Salivary flow from bilateral submandibular glands was not decreased. Sialography revealed main duct dilation, and no sialolith was found. Salivary gland scintigraphy showed a slight decrease of submandibular gland function. After jelly-like material was excreted, the swelling of the submandibular glands disappeared. Hematological examination showed high levels of eosinophils and serum IgE. Allergy tests showed positive reaction for some antigens. Histologic examination of this material showed infiltration of eosinophils and remnants of epithelium. These findings are compatible with sialodochitis fibrinosa. For treatment, bromhexine chloride was administered, and the symptoms were remarkably relieved.

Clinical characteristics of so called eosinophilic otitis media

Objective: Although ‘eosinophilic otitis media’ is not as uncommon a condition as was previously believed, its cause and pathogenesis are not yet fully understood. The purpose of this study was to describe the clinical characteristics in patients with ‘eosinophilic otitis media’ to clarify its pathogenesis. Methods: Seven adult patients with persistent and intractable otitis media with viscous middle ear effusion containing many eosinophils, who were also under treatment for bronchial asthma, were studied. The following examinations were conducted: nasopharyngeal endoscopy, pure-tone audiometry, eustachian tube function test, temporal bone CT scan, blood analysis, bacterial and fungal culture of middle ear effusion, histological study of the middle ear and nasal specimens, and measurement of eosinophilic cationic protein (ECP) in middle ear effusion. Results: Some patients had persistent perforation with papillomatous granulation tissue arising from the mesotympanic mucosa, and all the patients had nasal polyposis. The pure-tone audiometry showed the mixed-type of hearing loss in all the patients, and the hearing level deteriorated progressively during the course in some patients. The eustachian tube function was not always poor but was patulous in some cases. The most severely diseased areas were in the eustachian tube and mesotympanum by temporal bone CT images. All the seven patients had the high levels of total serum IgE, but the RAST scores were negative in three patients and low grade in three patients. The accumulation of eosinophils was observed in middle ear effusion, middle ear mucosa and nasal polyps, and the eosinophils were highly activated with degranulation. High level of ECP was also recovered from middle ear effusion. Conclusions: Active eosinophilic inflammation occurs in the entire respiratory tract, including the middle ear in these patients. From our present investigation, we propose the criteria and clinical characteristics of ‘eosinophilic otitis media’.

Allergy to Dermatophagoides in a Group of Spanish Gypsies: Genetic Restrictions

Background: Spanish gypsies have traditionally lived as nomads, a reason why few epidemiological studies were done in this ethnic group. However, the high prevalence of asthmatic diseases demonstrated in a population residing in the North of Spain induces us to analyse whether it was due to the influence of genetic loci previously implicated in other population studies as causing the disorders. Methods: DRB1* and DQB1* HLA class II, TCR-Vα8.1, FcΕRI-β Rsa I exon 7 and intron 2, TNF-β (LTα-Nco I) and CD14, were tested for association with asthma and atopy by multiple regression analysis, in 5 families comprising 87 individuals. Results: Significant associations were found with DQB1*02 (p = 0.02) and DQB1*0301 (p = 0.008) and elevated levels of total serum IgE. A negative association (p = 0.02) was found between total serum IgE and DRB1*14. FcΕRI-β Rsa I-In2 allele 1 was associated with high levels of total serum IgE (p = 0.04). Levels of Der p 1 IgE antibodies were negatively associated with DRB1*11-DQB1*0301 (p = 0.007), and positively with TCR Vα-8 allele 1 (p = 0.04) and with FcΕRI-β Rsa I-In2 allele 1 (p = 0.009). Conclusions: Our results do not show any association between asthma and the genetic loci studied although they do suggest the existence of multiple genetic influences on the allergic response in these families.

Effect of gas cooking on lung function in adolescents: modifying role of sex and immunoglobulin E

BACKGROUNDA study was undertaken to investigate the effect of gas cooking on the lung function of adolescents while considering serum IgE level as a possible effect modifier.METHODThe cross sectional study was performed in 702 subjects aged 11–13 years from primary and secondary schools in Civitavecchia and Viterbo ( Latium region in Central Italy), categorised according to how often they were in the kitchen while the mother cooked (never, sometimes, often). Data were collected by questionnaire and lung function was measured by spirometric tests. Bronchial hyperresponsiveness was evaluated by the methacholine test, atopic status by a skin prick test, and a blood sample was collected to determine serum IgE levels. The results were analysed separately for boys and girls. Multiple regression analysis was performed, taking functional parameters (FEV1, FEV1/FVC, FEF25–75, FEF50, FEF75) as the dependent variables and age, height, parental smoking, and father's education as independent variables.RESULTSThere was no association between time spent in the kitchen and lung function level in boys, but a reduction in lung function was detected in girls which was statistically significant for FEF75(sometimes –10.3%, often –11.1%). After stratifying boys and girls into four groups on the basis of the IgE serum level (below and above the median value of IgE), the reduction in lung function was significant in girls with a high IgE value whereas no significant deleterious effects were evident in girls with a low IgE value or in boys with either a low or high IgE. The results remained substantially unchanged after excluding girls with a response to methacholine below the concentration of 4 mg/ml, asthmatic patients, and those with positive skin prick tests.CONCLUSIONGas cooking has a harmful effect on the lung function of girls with a high serum level of IgE. We do not know whether serum IgE, a marker of allergic susceptibility, is a simple indicator that an inflammatory process is in progress or whether it is involved in the pathogenesis of injury leading to bronchial obstruction.

Effect of gas cooking on lung function in adolescents: modifying role of sex and immunoglobulin E

BACKGROUNDA study was undertaken to investigate the effect of gas cooking on the lung function of adolescents while considering serum IgE level as a possible effect modifier.METHODThe cross sectional study...

Reduction of serum interleukin-5 levels reflect clinical improvement in patients with atopic dermatitis.

Cytokines, in particular IL-4 and IL-5, regulate IgE synthesis and eosinophil activation in atopic dermatitis (AD). To elucidate whether the serum levels of IL-4 and IL-5 are related to the serum IgE level, eosinophilia, or clinical severity of the disease, 25 cases with AD were studied. Blood samples were isolated from two groups of donors: 1) patients with AD (n = 25); 2) non-allergic individuals (NA, n = 20) with serum IgE levels below 100 IU/ml and with blood eosinophil counts below 250/microliter. Each parameter was evaluated at least twice in AD patients at the beginning of the study and after 4, 8 or 12 weeks of treatment. IL-4 was hardly detected in AD and NA, but IL-5 was increased (> 10 pg/ml) in most cases (22/25) of AD group with 513.6 pg/ml as the mean. AD with normal serum IgE levels exhibited increased levels of IL-5, whereas AD with high serum IgE levels did not necessarily have elevated IL-5 levels. The IL-5 level tended to change in parallel with the clinical severity in each AD case, although the level itself was not correlated with the clinical severity per se. A significant decrease of IL-5 was observed in AD when the clinical severity decreased. Eosinophils also decreased along with the improvement of AD, whereas the serum level of IgE did not change during the observation period. Our results suggest that IL-5 is involved in the regulation of clinical courses of AD and that its kinetics at the serum level reflects the clinical activity of AD.

Effects of Retinoids on in vitro and in vivo IgE Production

Background: Retinoids modulate the growth and number of different cell types, including B cells. We could previously show that retinoic acid (RA) strongly inhibits CD40 + IL-4-mediated IgE production in vitro. The aim of the present study was to extend these findings regarding the potential use of retinoids for the treatment of allergic diseases. Methods: In vitro IgE production was studied in anti-CD40 + IL-4-stimulated peripheral blood mononuclear cells (PBMC) from allergic donors in the presence of 10^–15–10^–5M all-trans and 13-cis RA and in ovalbumin (OVA)-sensitized BALB/c mice treated with RA (20 mg/kg) before and during sensitization. IgE and IgG1 levels were determined in the sera of the mice at day 21 after 2 injections (days 1 and 8) of aluminum hydroxide-absorbed OVA. Results: All-trans and 13-cis RA inhibited in vitro IgE production from PBMC in a dose-dependent manner, but were more efficient in atopic dermatitis patients with low total serum IgE levels (<400 kU/ml), maximal inhibition for all-trans RA at 10^–7M (87%) and for 13-cis RA at 10^–5M (96%) compared to patients with high serum IgE levels (>2,000 kU/ml), maximal inhibition for both all-trans and 13-cis RA at 10^–5M (53 and 39%, respectively). In contrast, the in vivo data from OVA-sensitized mice revealed comparable total IgE and IgG1 levels in control versus all-trans RA or CD336-treated groups, specific IgE was even higher in the CD336-treated group (n = 10, 2,814 ng/ml), and was comparable in mice treated with OVA alone or with additional all-trans RA (n = 10, 1,447 and 1,354 ng/ml, respectively). Conclusions: These results indicate that the efficacy of retinoids to inhibit IgE production in vitro depends on the frequency of switched cells in the peripheral blood and that in an in vivo model using OVA-sensitized mice, retinoids fail to inhibit IgE production.

Prevalence of IgE antibodies to an extract from rubber tree (Hevea brasiliensis) latex and recombinant pollen allergens (Phl P 1, Phl P 2, Phl P 5, Bet v 1 and Bet v 2) in the sera of Italian atopic patients

Previous studies have reported cross-reactivity between latex and grass allergens. Inhibition studies have indicated cross-reactivity of IgE with latex and grass pollen proteins. A panel consisting of a few recombinant allergens, namely rPhI p 1, rPhl p 2, rPhl p 5 and profilin, was sufficient to diagnose grass pollen allergy in patients allergic to grass pollen. Serum samples from 528 consecutive outpatients with IgE antibodies towards at least one allergen (IgE level > 0.35 kAU/L) were selected for this retrospective study. Total and specific serum IgE to rPhl p 1, rPhl p 2, rPhl p 5, rBet v 1, rBet v 2, latex, birch, hazel, mugwort, wall pellitory, Dermatophagoides pteronissinus, Alternaria tenuis, cat and apple were measured by the immunoenzymatic capsulated hydrophilic carrier polymer (CAP) FEIA system (Pharmacia & Upjohn). Of 123 polysensitized patients with antilatex Ig1E, 12 (9.76%) had symptoms after latex exposure. Ten of 12 subjects monosensitized to latex had symptoms after latex exposure. Symptomatic patients had higher IgE levels to latex than symptomless patients (P = 0.046). A higher prevalence of antilatex IgE was seen in sera containing specific IgE to rPhl p 1, rPhl p 5 and rBet v 2. A good correlation (Spearman's r = 0.52; P = 0.001) between high levels of antilatex IgE and total serum IgE was found. The findings of the present study may support the concept that a high proportion of sera containing IgE to rBet v 2, rPhl p 1 and rPhl p 5 simultaneously contain antilatex IgE. Therefore, patients with specific IgE to these recombinant allergens with no history of current latex exposure may need additional evaluation.