Specific Immunoglobulin E Levels Research Articles

A Comprehensive Analysis of Immunoglobulin E Levels, Allergen-Specific Sensitivities, and Clinical Manifestations in Allergic Dermatological Conditions: A Multicenter Retrospective Study in China.

To assess the correlations between Immunoglobulin E (IgE) levels, pruritus, and lesion severity in patients with eczema, atopic dermatitis, or urticaria. A retrospective study was conducted and data of 814 patients who visited the dermatology or allergy clinics of multiple hospitals, from December 2019 to December 2021, were collected. Patients were divided into children group (<18 years, 325 cases), adult group (18-60 years, 435 cases), and older population group (>60 years, 54 cases) based on the age. Baseline information, pruritus severity, severity of skin lesions, total IgE level, and specific IgE level were recorded to analyze the complex relationship between them. The prevalence of allergic conjunctivitis and allergic rhinitis in the children group was significantly higher than that in the adult and older population group (P < 0.01 or P < 0.05). The positive rate of specific IgE in children group was significantly higher than that in the adult and older population group (P < 0.01). The IgE levels in children with moderate pruritus were significantly lower than those of severe pruritus (63.39vs 114.42 IU/mL, P < 0.05). The IgE levels in children with mild and moderate skin lesions were significantly lower than those in children with severe skin lesions (58.95 vs 72.88 vs 169.15 IU/mL, P < 0.001 or P < 0.01, respectively). Relationships among age, severity of skin pruritus and lesions, and allergen-specific IgE response are complex and subtle, displaying dynamic patterns.

Clinical outcome and component-specific antibody levels in egg allergic children after lightened oral immunotherapy.

To evaluate the clinical outcome of lightened version of egg oral immunotherapy (OIT) and to analyze egg allergen component-specific antibody levels during short up-dosing with egg white powder and maintenance by egg in daily diet. Eighteen egg-allergic children received egg powder with short up--dosing and they maintained tolerance using egg in daily diet. Seventeen egg-allergic children served as a control group. Component-resolved analysis of serum immunoglobulin E (IgE), IgA1, IgA2, and IgG4 levels were determined at inclusion, after up-dosing and after 1 year of immunotherapy. Skin-prick tests were performed at inclusion and after 1 year of therapy. All 18 patients in the egg OIT group were successfully desensitized. Desensitization was achieved on average in 4.5 months. In the control group, only two children tolerated egg in oral food challenge after 1 year. Of the measured immune markers, smaller wheal diameters in skin-prick testing, reduction in component-specific IgE levels, and increase in component-specific IgA1, IgA2, and IgG4 levels were associated with desensitization. A lightened egg OIT is effective and safe in children with egg allergy. Increase in all egg component-specific IgA1, IgA2 and IgG4 levels and decrease in all egg component--specific IgE levels were observed after 12 months of OIT.

Оцінка сироваткового загального та специфічного імуноглобуліну Е в дітей з персистуючим алергічним ринітом і поєднаним із бронхіальною астмою при сенсибілізації до алергенів кліщів

Allergic rhinitis (AR) is a common immunoglobulin E (IgE) dependent disease among allergic patients worldwide. At the same time, the determination of specific IgE in the blood serum allows characterizing the relevant sensitizing allergens. Despite the existence of conditional thresholds for normal and elevated levels of total and specific IgE, there is no consensus in the literature on which IgE value unequivocally confirms the presence of atopy and what is the relationship between these levels and the severity of clinical manifestations. Purpose - to evaluate the levels of serum total and specific IgE and their relationship with severity and age in children with persistent AR and combined with bronchial asthma (BA) during sensitization to house dust mite (HDM) allergens. Materials and methods. A clinical, anamnestic and laboratory examination of 259 children aged 5 to 17 years with AR and combined AR with BA, who were sensitized to HDM allergens, was conducted. Results. In AR in children with sensitization to HDM, there is a dependence of serum total IgE level on the severity of AR and age of children. With increasing severity of AR manifestations, a significant (p&lt;0.05) increase in total IgE levels was noted. It was found that the content of sIgE also increased with increasing severity of AR. Thus, statistically significantly (p&lt;0.05) higher levels of sIgE were determined in sensitization to the major HDM molecules Der f 1, Der p 1, Der p 2, Der p 23 in children with severe AR. Sensitization to the tropomyosin Der p10 molecule, which usually has no effect on the clinical manifestations of respiratory allergy but indicates cross-reactivity to seafood, was significantly more common (p&lt;0.05) in children aged 3-7 years compared to children aged 13-17 years. Conclusions. The data obtained partially define the pathogenetic features in the formation of sensitization to HDM and their individual molecules, confirming that this process begins at an early age, which may indicate the need to start allergen-specific immunotherapy in such children if clinically necessary. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Clinical Features of Quail Egg Ingestion in Patients with Acquired Tolerance to Hen Eggs: A Case Series Study

Introduction: Patients with hen’s egg allergy are often instructed to avoid consuming other avian eggs, such as quail eggs. However, it is unclear whether patients with an acquired tolerance to hen eggs continue to avoid consuming quail eggs. This study aimed to evaluate the clinical features of quail egg ingestion. Methods: This prospective case series included children aged ≥1 year with hen’s egg allergy who were recruited between October 2019 and February 2021 in our hospital. We conducted an oral food challenge (OFC) with three boiled quail eggs to evaluate the clinical features of quail egg ingestion in patients with acquired tolerance to hen eggs. The primary outcome was a positive OFC after ingesting three quail eggs. Secondary outcomes were cross-antigenicity between hen and quail eggs observed through the skin prick test (SPT) and pattern of quail egg allergy, comprising the onset of reaction, and severity. The correlation between the diameters of the wheals with SPT in hen and quail eggs was evaluated using the Pearson product-moment correlation coefficient. Results: A total of 62 patients underwent the quail egg OFC. The median (interquartile range) age of the participants was 3 (2–5) years. Thirty-three (53%) patients had a history of anaphylaxis due to hen eggs. The median total immunoglobulin E (IgE) level in patients who underwent the OFC with half a heated whole hen’s egg was 271 (98–593) IU/mL. The median specific IgE level in egg white and ovomucoid was 9.7 (3.2–21.5) and 4.4 (1.3–6.9) UA/mL, respectively. The quail egg OFC results revealed that none of the 59 patients who ate the three quail eggs completely had an allergic reaction. The SPT-positive and SPT-negative rates in raw and boiled hen and quail egg whites were both correlated. The diameters of wheals with SPT in raw hen and quail egg whites and yolks were positively correlated. Conclusion: Patients with an acquired tolerance to hen eggs may not be required to avoid consuming quail eggs.

Basophils Predict Mite Sensitization in Patients with Kawasaki Disease.

Background: Patients with Kawasaki disease (KD) are at a significantly increased risk of allergic diseases. Immunoglobulin E (IgE) is an immunoglobulin that mediates allergic sensitization to various allergens and is related to various allergic diseases. However, few studies have analyzed specific IgE on allergy biomarkers after KD is diagnosed. Objective: This study aimed to investigate the pattern of specific IgE levels against food and inhalant allergens. Methods: This retrospective study was conducted in Taiwan to identify patients admitted with KD. A subset of 453 admitted KD children younger than or equal to five years of age with intravenous immunoglobulin (IVIG) was followed up at our clinic with available specific IgE data. Results: The most common allergens were Dermatophagoides farina or pteronyssinus, house-dust, and cockroach mix. Positive specific IgE for Dermatophagoides farina or pteronyssinus was less common in children diagnosed with KD who were two years old or younger (p = 0.028). KD patients with higher basophils before IVIG (p = 0.010 and 0.018 for two different mites) and higher C-reactive protein (CRP, p = 0.030 and 0.028) after IVIG were at higher risk of mite sensitization. Integrated mite sensitization demonstrated higher basophils before IVIG, age at KD diagnosis, and the male sex to be clinically meaningful after logistic regression models. Conclusions: This study is the first to suggest that specific IgE in KD patients may be correlated with age at KD diagnosis, as well as basophils. Further longitudinal prospective studies are warranted to clarify the unique profile of specific IgE in KD patients.

Milk Allergen Micro-Array (MAMA) for Refined Detection of Cow's-Milk-Specific IgE Sensitization.

Immunoglobulin-E(IgE)-mediated hypersensitivity to cow's milk allergens is a frequent cause of severe and life-threatening anaphylactic reactions. Besides case histories and controlled food challenges, the detection of the IgE antibodies specific to cow's milk allergens is important for the diagnosis of cow-milk-specific IgE sensitization. Cow´s milk allergen molecules provide useful information for the refined detection of cow-milk-specific IgE sensitization. A micro-array based on ImmunoCAP ISAC technology was developed and designated milk allergen micro-array (MAMA), containing a complete panel of purified natural and recombinant cow's milk allergens (caseins, α-lactalbumin, β-lactoglobulin, bovine serum albumin-BSA and lactoferrin), recombinant BSA fragments, and α-casein-, α-lactalbumin- and β-lactoglobulin-derived synthetic peptides. Sera from 80 children with confirmed symptoms related to cow's milk intake (without anaphylaxis: n = 39; anaphylaxis with a Sampson grade of 1-3: n = 21; and anaphylaxis with a Sampson grade of 4-5: n = 20) were studied. The alterations in the specific IgE levels were analyzed in a subgroup of eleven patients, i.e., five who did not and six who did acquire natural tolerance. The use of MAMA allowed a component-resolved diagnosis of IgE sensitization in each of the children suffering from cow's-milk-related anaphylaxis according to Sampson grades 1-5 requiring only 20-30 microliters of serum. IgE sensitization to caseins and casein-derived peptides was found in each of the children with Sampson grades of 4-5. Among the grade 1-3 patients, nine patients showed negative reactivity to caseins but showed IgE reactivity to alpha-lactalbumin (n = 7) or beta-lactoglobulin (n = 2). For certain children, an IgE sensitization to cryptic peptide epitopes without detectable allergen-specific IgE was found. Twenty-four children with cow-milk-specific anaphylaxis showed additional IgE sensitizations to BSA, but they were all sensitized to either caseins, alpha-lactalbumin, or beta-lactoglobulin. A total of 17 of the 39 children without anaphylaxis lacked specific IgE reactivity to any of the tested components. The children developing tolerance showed a reduction in allergen and/or peptide-specific IgE levels, whereas those remaining sensitive did not. The use of MAMA allows for the detection, using only a few microliters of serum, of IgE sensitization to multiple cow's milk allergens and allergen-derived peptides in cow-milk-allergic children with cow-milk-related anaphylaxis.

An Investigation of the Relationship Between Isolated Anti-dense Fine-Speckled 70 Autoantibodies and Allergen-Specific Immunoglobulin E.

Background Although the mechanisms of the formation of anti-dense fine-speckled 70 (anti-DFS70) antibodies are not fully known, there is evidence in the literature that allergic reactions may play a role in their formation. Immunoglobulin E (IgE)-mediated immunopathological mechanisms are increasingly being elucidated in diseases such as atopic dermatitis and urticaria-related diseases. We aimed to reveal its relationship with anti-DFS70 in allergen-sensitive patients with positive specific IgE (sIgE) levels. Methodology The study included samples of 758 patients who underwent antinuclear antibody (ANA) screening and allergen-sIgE testing between January 2019 and January 2022. Patients' clinical diagnoses were retrospectively obtained from the hospital information management system. ANA was tested according to the instructions of the manufacturer by the indirect immunofluorescent antibody method using HEp-2 cell substrates (Euroimmun Luebeck, Germany). Allergen-sIgE was determined by chemiluminescence on the Immulite 2000 XPI system (Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany) according to the instructions of the manufacturer. Results ANA pattern was detected in 74 samples included in the study. ANA-positive patients were divided into DFS70 (+) and DFS70 (-) groups. A statistically significant increase in the DFS70 pattern was observed in patients with a positive allergen-sIgE test (p < 0.0001). Both allergen-sIgE and DFS70 positivity were statistically significant in younger age groups (p < 0.05). The most common diagnosis was urticaria-related conditions in 23 (31%) patients with a positive allergy test. Conclusions Our study shows that the positivity of the DFS70 pattern is increased in allergen-sensitive patients. Therefore, the allergen-sIgE-mediated allergic disease should be considered in patients with isolated anti-DSF70. Studies with related disease groups are needed to determine whether there is a relationship between anti-DFS70 and allergy-related disease in these patients. If an immunopathological mechanism is not found, these false-positive results can be considered clinically insignificant, and unnecessary consultations can be avoided.

Association between poly-sensitisation and sensitisation to staphylococcal enterotoxin A and B affecting allergic severity in children.

Accumulating evidence suggests that Staphylococcus aureus plays a significant role as a disease modifier in upper and lower airway diseases. We aimed to assess the association between staphylococcal enterotoxins (SEs) with allergic diseases and the degree of allergen sensitisation in children, which remains unclear. We retrospectively reviewed the medical records of 455 patients aged 3-18years between March 2018 and March 2022. Clinical history and demographic data were obtained. The baseline study included paranasal sinus X-ray scan, multiple allergen simultaneous test, and ImmunoCAP® for measuring serum total and specific immunoglobulin E (IgE) levels to allergens and staphylococcal enterotoxin A and B (SEA and SEB). The mean age was 9.77 ± 4.3years. 133 patients (29.2%) were sensitised to one inhalant allergen, and 188 patients (41.3%) showed polysensitisation. Patients sensitised to SEs showed higher total and specific IgE levels and total eosinophil counts compared to non-SE-sensitised patients. Sensitisation to SEs is closely associated with polysensitisation to inhalant allergens and allergic multimorbidity. When the SE-IgE value was 0.35 or higher, the odds ratio for allergen polysensitisation was significantly higher than when the SE-IgE value was lower than 0.35. Association between polysensitisation and sensitisation to SEs in children shows the higher the specific IgE levels for SEs, the higher the likelihood of polysensitisation. Considering the relationship between polysensitisation, high IgE levels, and the severity of allergic morbidity, sensitisation to SEs is thought to be related to allergy severity.

Sensitivity caused by Dermatophagoides pteronyssinus and D. farinae (Astigmata: Pyroglyphidae) in subjects with allergic rhinitis

The house dust mites (HDMs), defined here as members of the family Pyroglyphidae, are present just about everywhere in human dwellings and act as an important risk factor for allergic rhinitis (AR). They are a major perennial allergen source that causes AR. In the present study, 160 subjects clinically diagnosed with AR from the Department of Ear Nose Throat (ENT), Government Rajindra Medical College and Hospital, Patiala, India, and 30 non-allergic healthy, control individuals were selected. Blood samples were taken from all these study subjects for serological testing and ImmunoCAP™ Phadia™ 100 was used for the detection of total and HDM specific immunoglobulin E (IgE) levels. To detect total IgE levels, a mixture of 14 different allergens was used and, for HDM specific IgE, a mixture of Dermatophagoides pteronyssinus (Trouessart) and D. farinae Hughes allergens. Dust samples were taken from mattresses used by the study subjects with the help of a vacuum cleaner. A floatation method was used for the extraction of mites. Hoyer’s medium was used for the preparation of slides for microscopy. Total IgE levels were elevated in all AR subjects and HDM specific IgE levels were found to be positive in 54.38% of them. Analysis of dust samples showed that 72.50% of samples from the mattresses of AR subjects were found to be positive for the HDMs D. pteronyssinus and D. farinae and 33.33% of those from the control group. Total and HDM specific IgE levels of AR subjects showed statistically significant correlation with each other, but in the control group no such correlation was found. Moreover, a significant result was found between the positive HDM specific IgE levels and the number of D. pteronyssinus and D. farinae found in their respective dust samples. In conclusion, the total IgE and positive HDM specific IgE levels showed that there was a chance of allergic reaction in rhinitis subjects. Furthermore, the significant statistical analysis between positive HDM specific IgE levels against D. pteronyssinus and D. farinae, and the higher prevalence of these two species in the houses sampled provided support for these mites being the major allergen sources for the symptoms of AR in the study area.

Molecular Allergen-Specific IgE Recognition Profiles and Cumulative Specific IgE Levels Associated with Phenotypes of Cat Allergy.

Cat allergy is a major trigger factor for respiratory reactions (asthma and rhinitis) in patients with immunoglobulin E (IgE) sensitization. In this study, we used a comprehensive panel of purified cat allergen molecules (rFel d 1, nFel d 2, rFel d 3, rFel d 4, rFel d 7, and rFel d 8) that were obtained by recombinant expression in Escherichia coli or by purification as natural proteins to study possible associations with different phenotypes of cat allergy (i.e., rhinitis, conjunctivitis, asthma, and dermatitis) by analyzing molecular IgE recognition profiles in a representative cohort of clinically well-characterized adult cat allergic subjects (n = 84). IgE levels specific to each of the allergen molecules and to natural cat allergen extract were quantified by ImmunoCAP measurements. Cumulative IgE levels specific to the cat allergen molecules correlated significantly with IgE levels specific to the cat allergen extract, indicating that the panel of allergen molecules resembled IgE epitopes of the natural allergen source. rFel d 1 represented the major cat allergen, which was recognized by 97.2% of cat allergic patients; however, rFel d 3, rFel d 4, and rFel d 7 each showed IgE reactivity in more than 50% of cat allergic patients, indicating the importance of additional allergens in cat allergy. Patients with cat-related skin symptoms showed a trend toward higher IgE levels and/or frequencies of sensitization to each of the tested allergen molecules compared with patients suffering only from rhinitis or asthma, while there were no such differences between patients with rhinitis and asthma. The IgE levels specific to allergen molecules, the IgE levels specific to cat allergen extract, and the IgE levels specific to rFel d 1 were significantly higher in patients with four different symptoms compared with patients with 1–2 symptoms. This difference was more pronounced for the sum of IgE levels specific to the allergen molecules and to cat extract than for IgE levels specific for rFel d 1 alone. Our study indicates that, in addition to rFel d 1, rFel d 3, rFel d 4, and rFel d 7 must be considered as important cat allergens. Furthermore, the cumulative sum of IgE levels specific to cat allergen molecules seems to be a biomarker for identifying patients with complex phenotypes of cat allergy. These findings are important for the diagnosis of IgE sensitization to cats and for the design of allergen-specific immunotherapies for the treatment and prevention of cat allergy.

Profiles of sensitization and comorbidity in asthma patients with markedly increased serum total IgE (>1000kU/L).

Background: Immunoglobulin E (IgE) plays an important role in asthma, but a few patients exhibit extremely high levels of serum total IgE. Objective: This study aimed to investigate the profiles of comorbidity and/or complications, severity, and sensitizations in patients with asthma and with a total IgE level > 1000 kU/L. Methods: We retrospectively analyzed 170 patients with asthma and with total IgE levels of >1000 kU/L from the inpatient data base. Available information, including age, gender, body mass index, diagnosis, results of routine blood tests, pulmonary function, fractional exhaled nitric oxide, induced sputum (if any), IgE (both total and specific) tests and medication records were analyzed. Results: In the study subjects, >80% were adults, and the average total IgE level was median (interquartile range) 1438 kU/L (1181-2255 kU/L). Approximately 15% of the subjects had at least one comorbidity and/or complication, and 78.82% of the subjects were positive for at least one allergen. Airway infections (44.71%) and rhinosinusitis (41.18%) accounted for the two most common conditions despite age groups. Total IgE levels did not differ among the subjects with different conditions. Overall, mites had the highest positive rate (59.4%). Serum total IgE levels were positively correlated with house-dust mite specific IgE (sIgE) levels (r = 0.23; p < 0.05), peripheral blood eosinophil counts (r = 0.21; p < 0.01), and the number of confirmed sIgE positivity (r = 0.19; p < 0.01), and optimal scaling analysis showed that asthma severity was associated with Aspergillus fumigatus sIgE levels. Conclusion: In the subjects with asthma and with a total IgE level of >1000 kU/L, the two most common conditions were airway infections and rhinosinusitis, despite sensitization. A. fumigatus sIgE levels were closely associated with total IgE levels and asthma severity.

Investigation of the sensitization rate for gibberellin-regulated protein in patients with Japanese cedar pollinosis.

Pollen-food allergy syndrome (PFAS) usually manifests as an itching sensation in the mouth and throat immediately after eating fresh fruits and vegetables. However, some patients with PFAS experience systemic symptoms including anaphylaxis. In Europe, cypress gibberellin-regulated protein (GRP) has been noted to cause allergenicity and exhibit cross-reactivity with peach GRP. Japanese cedar (Cryptomeria japonica), classified in the cypress family, is the primary causative substance among all environmental allergens in Japan. However, studies on the prevalence of GRP sensitization in patients with cedar pollinosis are lacking. This study examined the prevalence of GRP sensitization in patients with Japanese cedar pollinosis. We enrolled 52 patients who had requested sublingual immunotherapy treatment with mild-to-severe rhinitis during spring, and had a JCP-specific immunoglobulin E (IgE) levels of >0.7 UA/mL. Peach GRP was purified using affinity chromatography with a monoclonal antibody column. Specific IgE levels to peach GRP were measured using an enzyme-linked immunosorbent assay. Samples exhibiting absorbance at 450 nm of over mean plus three standard deviations of the negative control value were defined as positive. Sera from three patients with severe peach allergy were used as positive controls. Eleven sera from 52 patients with JCP-induced allergic rhinitis were positive for peach GRP. Twenty percent of patients with cedar pollinosis were sensitized to peach GRP. Well-powered studies are needed to clarify whether these patients are at an increased risk for systemic symptoms or whether they primarily demonstrate only localized symptoms.

Influence of the COVID-19 pandemic on the incidence and exacerbation of childhood allergic diseases.

To explore the influence of changes in human lifestyle and the living environment caused by nonpharmaceutical interventions in coronavirusdisease 2019 (COVID-19) on allergic diseases, the present study enrolled children who came to the Children's Hospital of Zhejiang University for allergen detection between January 2019 and December 2020. By comparing the positive rates and levels of various allergen-specific immunoglobulin E (IgE) before and during the COVID-19 pandemic, the influence of changes in human lifestyle and the living environment caused by prevention and control measures in COVID-19 on allergic diseases was evaluated. In 2019, 41 648 allergic children went to the hospital, but in 2020, due to the impact of the COVID-19 epidemic, the number decreased to 24 714. In 2020, the number of allergy visits was the lowest in February and gradually increased. There were 45 879 children with total IgE > 17.5 IU/ml in 2 years, accounting for 69.13% of the total samples, of which the proportion was 68.52% (28 536/41 648) in 2019and 70.17% (17 343/24 714) in 2020. A total of 29 906 children were positive for one or more allergens in 2 years. It accounts for 45.06% of the total number of samples, of which the proportion is 41.53% (17 296/41 648) in 2019and 51.02% (12 610/24 714) in 2020. Except for cashew nuts, the positive number of other allergens in 2020 was less than in 2019, especially after June and July 2020. Except for Artemisia argyi, the positive rates of other allergens in 2020 were significantly higher than those in 2019 (p < 0.05). Moreover, the changing trend of the positive allergen rate in each month in 2020 was different from that in 2019. In 2020, except for Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Crab, specific IgE levels of other allergens were not greater than those in 2019 (p < 0.05). Thus it can be seen, during the COVID-19 pandemic, nonpharmaceutical interventions played a protective role in reducing children's exposure to allergens and alleviating allergic reactions.

Allergen Specificity in Specific IgE Cutoff

To assess the clinical relevance of specific immunoglobulin E (IgE) cutoffs for aeroallergens in children.The population studied includes 6-year-old Danish children in the Copenhagen Prospective Study on Asthma in Childhood in 2000 and 2010.The distribution of 5 common aeroallergens (house dust mite [HDM], cat, dog, grass, and birch) were assessed among children in these cohorts at 6 years old. Levels were compared between the entire population studied and children with pediatrician-diagnosed allergic rhinitis.The median value of specific immunoglobulin E (sIgE) in children varied across groups; all children had a median sIgE of 0.14 (HDM), 0.06 (cat), 0.07 (dog), 0.33 (grass), and 0.2 (birch) kUA/L; symptomatic children with rhinitis had a sIgE of 6.29 (HDM), 1.41 (cat), 5.73 (dog), 2.43 (grass), and 1.97 (birch) kUA/L. In symptomatic children, the median values were higher and had increased variation. There was significant overlap between the 2 sets, with high IgE levels even in some of the asymptomatic children.A uniform cutoff was not found among the allergens tested that discriminate between symptomatic and asymptomatic individuals.Currently, there are no established cutoffs for allergen specific IgE levels that distinguish clinical allergy from asymptomatic sensitization. Having clinically relevant cutoffs for specific IgE levels that correlate with clinical symptoms would facilitate interpretation of test results. The authors’ comparison of allergen specific IgE levels in a prospective cohort of children with a subgroup that had pediatrician-diagnosed allergic rhinitis reveals that there is important overlap of IgE levels between the 2 groups. Similar to food and venom allergy, having detectable IgE has not equate to clinical allergy. In this prospective asthma study, Schoos et al should consider the role of a diagnosis of asthma on the clinical relevance of the sensitization noted, when appropriate to make correlations. Further studies will be needed to determine if allergen specific cutoffs can be established for the diagnosis of rhinitis and asthma.

Specific IgE levels as an outcome predictor in egg-allergic children.

Diagnosis of immunoglobulin E (IgE)-mediated egg allergy is often based on both a compatible clinical history and either elevated IgE levels or a positive skin prick test. However, the gold standard is the oral food challenge (OFC). Previous studies have pointed to a correlation between IgE levels and OFC outcomes. This study aimed to determine the relationship between IgE levels and the outcome of OFC, seeking to establish cut-off OFC values that indicate a high likelihood of positive OFC results. A total of 198 patients who underwent OFC (and a serological IgE antibody assay within the three preceding months) were reviewed and divided by OFC type (i.e., baked, cooked, or raw egg). IgE-specific levels were assessed against the challenge outcome as well as cut-offs proposed by other authors. Receiver-operating characteristic (ROC) curve analysis yielded a potentially useful ovomucoid IgE-specific cutoff used in OFC with cooked egg and several egg white and ovalbumin IgE-specific cut-offs for OFC with raw egg. We found no significant relationship between other specific IgE concentrations and the challenge threshold level with baked eggs. IgE-specific concentrations are useful as predictors of OFC outcome and should be considered when selecting patients challenge testing with boiled or raw egg. However, patients should undergo OFC with baked egg regardless of IgE levels.

High level of IgE in acute low-tone sensorineural hearing loss: A predictor for recurrence and Meniere Disease transformation

BackgroundAutoimmunity may play an important role in sudden onset sensorineural hearing loss. However, little is known about the relationship between immunoglobulin E (IgE) and acute low-tone sensorinerual hearing loss (ALHL). ObjectivesTo investigate the relationship between IgE level and endolymphatic hydrops and outcomes of ALHL. MethodsA total of 242 subjects with sudden onset hearing loss, including 115 with ALHL and 127 with idiopathic sudden sensorineural hearing loss (ISSHL), were included in this study. Peripheral venous blood samples of 242 subjects were collected for detection. Clinical data, IgE level, and distribution of allergens were compared between the ALHL and ISSHL groups. The ALHL group received an electrocochleogram (ECochG) test and a follow-up in the outpatient unit or by telephone to evaluate outcomes. ResultsCompared to the values in the ISSHL group, a significantly younger onset age (42.30±14.33 years old), higher female onset proportion (72/115, 62.61%), increased total IgE level (median: 66.47, interquartile range: 24.56, 180.96, IU/mL) and specific IgE level (median: 9.42, interquartile range: 1.42, 22.23 IU/mL) were noted in the ALHL group. A clear difference in allergen distribution was noted between the ALHL and ISSHL groups (p=.001). Total IgE and specific IgE levels were factors that contributed to the SP/AP ratio in the electrocochleogram (ECochG) (R2=0.413) in ALHL group. Finally, during the follow-up (17.61±3.46 months) for the ALHL group, 37 subjects recurred, and 17 subjects developed Meniere Disease. In the ROC curve for ALHL recurrence, the area under the curve (AUC) of total IgE was 0.709 and that of specific IgE was 0.679. For MD transformation, the AUC of total IgE was 0.736 and that of specific IgE was 0.716. ConclusionsHigh IgE levels correlated with an enhanced SP/AP ratio in ALHL. High IgE levels could be used as a predictor of ALHL recurrence and MD transformation.

Eosinophil count, serum CCL17/18/26 and immunoglobulin E levels in atopic dermatitis: upadacitinib phase 2 study analysis

To assess upadacitinib (UPA), a selective JAK1 inhibitor, treatment on absolute eosinophil count (AEC), serum Type 2 biomarkers, total and allergen-specific immunoglobulin E (IgE) levels in patients with atopic dermatitis (AD). Adults with moderate-to-severe AD were randomized to daily placebo (PBO) or UPA 7.5, 15, or 30mg in a 16-wk, phase 2 study. Wk 16 AEC, serum biomarkers, total and allergen-specific IgE (ImmunoCap) levels, changes in Eczema Area and Severity Index (EASI) and pruritus numeric rating scale (NRS, weekly average of daily patient assessments) were analyzed. Statistical analysis was done using analysis of variance and Spearman correlation. Mean percentage improvements from baseline to wk 16 in EASI (39.4%/61.7%/74.4% vs 23.0%; P<0.05/<0.001/<0.001) and pruritus NRS (39.6%/48.0%/68.9% vs 9.7%; P<0.01/<0.001/<0.001) were significantly greater with UPA 7.5/15/30mg vs PBO. AEC was significantly lower with 30mg UPA vs PBO (P=0.01) at wk 16; significant differences were observed as early as wk 2 in UPA 15mg (P=0.003) and 30mg groups (P<0.0001) vs PBO. Serum levels of the Th2 cytokines, CCL18 and CCL26, and the Th22 cytokine, IL-22, were significantly lower with 15mg and 30mg UPA vs PBO as early as wk 2 (P<0.01); these significant decreases were sustained at wk 16 in UPA 15 and 30mg groups (P<0.01). CCL17 (TARC) showed similar trends (significant at wks 2 and 8 vs baseline) with UPA 30mg dose. There were no clear trends in Th17 cytokine levels (IL-17A, IL-17F, or CCL20). Baseline levels of AEC significantly correlated with baseline EASI (r=0.39, P<0.0001); in addition, percentage change from baseline to wk 16 in AEC correlated with percentage change at wk 16 in EASI (r=0.62, P<0.0001) and pruritus NRS (r=0.66, P<0.0001). Baseline serum levels of Th2 and Th22 cytokines significantly correlated with baseline EASI scores (CCL17/18/26: r=0.44/0.43/0.41, P<0.0001; IL-22: r=0.43, P<0.001). Changes from baseline to wk 16 in Th2 and Th22 cytokines correlated with percentage changes in EASI (CCL18/26: r=0.58/0.57, P<0.0001; IL-22: r=0.48, P<0.0001) and pruritus NRS (CCL18/26: r=0.37/0.43, P<0.01; IL-22: r=0.38, P<0.001). While baseline levels of serum total IgE correlated with baseline EASI (r=0.35, P<0.001), no trends in allergen-specific or total IgE levels as a function of study duration were observed. Eosinophil counts and serum levels of Th2 (CCL18/26) and Th22 (IL-22)-attracting chemokines were significantly reduced with UPA treatment (15/30mg) as early as wk 2, suggesting UPA may have early and robust effects on Th2, Th22, and eosinophil axes. No significant changes in total and specific IgE levels were observed, suggesting that UPA clinical efficacy is independent of IgE levels, and this observation coupled with the lack of clinical efficacy for anti-IgE strategies in patients with AD argues against the primary role of IgE in AD pathogenesis.

Immunoglobulin E-Binding Pattern of Canadian Peanut Allergic Children and Cross-Reactivity with Almond, Hazelnut and Pistachio.

Peanut allergic individuals can be both co-sensitized and co-allergic to peanut and tree nuts. At the moment, standard diagnostic approaches do not always allow differentiation between clinically relevant sensitization and nonsignificant cross-reactions, and the responsibility of each allergen remains unclear. The objective of this study was therefore to determine a peanut sensitization profile in a cohort of Canadian peanut allergic children and assess the immunoglobulin E (IgE) molecular cross-reactivity between peanut, almond, hazelnut and pistachio. The specific IgE (sIgE) levels of each patient serum were determined by ImmunoCAP, indirect ELISA and immunoblot to examine their sIgE-binding levels and profiles to peanut proteins. Reciprocal inhibition ELISA and immunoblotting were used to study sIgE cross-reactions between peanut and the selected tree nuts using an adjusted and representative serum pool of the nine allergic patients. The results showed that the prepared peanut and tree nut protein extracts allowed for the detection of the majority of peanut and selected tree nut known allergens. The reciprocal inhibition ELISA experiments showed limited sIgE cross-reactivities between peanut and the studied tree nuts, with peanut being most likely the sensitizing allergen and tree nuts the cross-reactive ones. In the case of hazelnut and pistachio, a coexisting primary sensitization to hazelnut and pistachio was also demonstrated in the serum pool. Reciprocal inhibition immunoblotting further revealed that storage proteins (2S albumin, 7S vicilin and 11S legumin) could possibly account for the observed IgE-cross-reactions between peanut and the studied tree nuts in this cohort of allergic individuals. It also demonstrated the importance of conformational epitopes in the exhibited cross-reactions.

Density of Dermatophagoides spp. and Its Relationship with House-dust Mite Specific Serum IgE in Persistent Asthma

Background: Asthma is a chronic inflammation of the bronchial tree that emerges as a response to exogenous factors, such as allergens, irritants, and infections. Some asthmatic patients had been reported having symptoms of asthma due to house-dust mites (HDM) allergen exposure. It is associated with immune responses which were increased in the form of specific Immunoglobulin E (IgE) production against HDM allergens. This case-control study aimed to determine the HDM profiles in persistent asthmatic patients, including density of mites, as well as its relationship with specific IgE anti-HDM serum levels.Materials and Methods: A total of 13 patients with persistent asthma and 12 control patients had their specific anti-HDM IgE levels examined using Immulite 2000 xpi. The house dust samples were taken and analyzed with the Fain method.Results: The results have shown that 69% of patients in the persistent asthma group and 25% of normal patients were positive for IgE anti-HDM. Dermatophagoides pteronyssinus is a predominant species with a total of 120 mites (83.9%) of 143 mites. Correlation analysis indicated a positive relationship between IgE anti-HDM levels within the serums of patients and the density of mites in the dust obtained from bedroom spaces (Spearmen Rho, R=0.35, p=0.04).Conclusion: Positive IgE anti-HDM patients in the persistent asthma group were higher (69%) than those in the clinically normal group (25%). The density of mites were dominated by D. Pteronyssinus. The bedroom-dust mites density revealed a positive correlation with serum IgE anti-HDM levels in persistent asthma patients.Keywords: asthma, density, Dermatophagoides spp.,IgE

Polymorphism -509C/T in TGFB1 Promoter Is Associated With Increased Risk and Severity of Persistent Allergic Rhinitis in a Chinese Population.

Polymorphism -509C/T in the promoter of transforming growth factor beta1 (TGFB1) gene is implicated in the pathogenesis of asthma. This polymorphism might also act to regulate the development of allergic rhinitis (AR). To investigate whether -509C/T is associated with AR susceptibility and severity in a Han Chinese population. The study enrolled 263 patients with persistent AR and 249 healthy controls. AR patients were classified as mild or moderate/severe AR groups according to the Allergic Rhinitis and its Impact on Asthma classification. TGFB1 gene polymorphism -509C/T was genotyped with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Serum total Immunoglobulin E (IgE) and specific IgE levels were determined using an ImmunoCAP. Significant difference was found in the allele frequency of TGFB1 -509C/T between AR patients and healthy controls (P = .027) but not in the genotype frequency (P =.051). However, the genotype frequency of TGFB1 -509C/T showed significant difference between the mild AR group, the moderate/severe AR group, and the control group (P = .012); between the moderate/severe AR group and the control group (P =.036); between the mild AR group and the moderate/severe AR group (P = .038); but not between the mild AR group and the control group (P =.075). TGFB1 promoter polymorphism -509C/T may be associated with the susceptibility and the severity of persistent AR of Han Chinese, but the functional relationship still needs clarification.