Immunoglobulin E deficiency: a forgotten clue pointing to possible immunodeficiency?

Unsworth, D J; Virgo, Paul; Lock, R J

doi:10.1258/acb.2011.011052

Cited by 19 publications

(22 citation statements)

References 14 publications

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“…These two patients had a diagnosis of bronchiectasis. Our results confirm the investigation by Unsworth and coworkers in their work ‘Immunoglobulin E deficiency: a forgotten clue pointing to possible immunodeficiency?’7 They found very low IgE (≤2 IU/mL) in 85/2622 (3.2%) routine patient samples. Two children and four adult patients were found to have one or more classes of immunoglobulin below the age-specific reference range.…”

Section: Discussionsupporting

confidence: 91%

“…Low IgE (<2 kU/L) found during allergy investigations may be a marker for other immunodeficiencies,7 including well defined immune deficiency diseases such as common variable immunodeficiency (CVID), hyper-IgM syndrome, selective IgM deficiency, IgG subclass deficiencies, ataxia telangiectasia and Bruton's or X-linked agammaglobulinaemia (XLA) 1. While Bruton's agammaglobulinaemia and ataxia telangiectasia present in infancy or early childhood, CVID can be diagnosed at any age with no sex preponderance.…”

Section: Introductionmentioning

confidence: 99%

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IgE deficiency may indicate underlying hypogammaglobulinaemia?

McVicker

Karim

2014

J Clin Pathol

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Low serum immunoglobulin E (IgE) (<2 kU/L) found during allergy investigations may be a marker for other immunodeficiency states, in particular common variable immunodeficiency. The latter is characterised by recurrent infections, mainly respiratory, resulting in structural lung damage making early diagnosis important. We looked through 4013 samples retrospectively over a 12-month period to identify samples with IgE<2 kU/L. We identified 74/4013 (1.84%) with serum IgE levels<2 kU/L. Only 20 samples had serum immunoglobulin quantification and serum electrophoresis requested. Three of these samples were from the same patient, 10/18 (56%) had one or more classes of immunoglobulin above/below reference range for age and two of these had new diagnosis of immunodeficiency. Serum IgE<2 kU/L can be a marker for hypogammaglobulinaemia or common variable immunodeficiency. As early diagnosis is important to reduce morbidity and mortality, very low serum IgE should trigger further investigation—that is, serum protein electrophoresis and immunoglobulin quantification.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

IgE deficiency may indicate underlying hypogammaglobulinaemia?

McVicker

Karim

2014

J Clin Pathol

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“…These data may suggest a growing importance and high incidence of non-IgE-mediated food allergic disorders in the children studied, accounting for up to 40% of milk protein allergy in infants and young children [22,23] and which manifest as profuse enterocolitis syndrome with diarrhea, repetitive vomiting and failure to thrive or as benign allergic proctocolitis with bloody stools. However, in children with hypogammaglobulinemia, as to isolated or combined immunoglobulin deficiencies, low serum IgE may rather reflect a multiple immunoglobulin deficit and therefore, the role of the non-IgE mediated allergic pathway in this group of immunodeficient children must be particularly emphasized [24,25].…”

Section: Discussionmentioning

confidence: 99%

IgA deficiency: a risk factor for food allergy-related atopic dermatitis in infants and young children

Szczawińka-Popłonyk¹,

Komasińska²,

Bręborowicz³

2016

pdia

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A b s t r a c t Introduction:The impaired immunosurveillance and dysfunctional antigen compartmentalization in primary immunodeficiencies may predispose affected children to allergic sensitization. Aim: The growing problem of allergic reactions to foods and the increase in non-IgE-mediated gastrointestinal disorders prompted us to investigate the impact of hypogammaglobulinemia on the prevalence and clinical phenotypes of food allergy. Material and methods:We performed a retrospective analysis of medical records of 78 infants and young children with deficiencies of one or more immunoglobulin isotypes and of 132 age-matched patients with normal immunoglobulin production in terms of prevalence and clinical manifestation of food allergy, atopic sensitization and physical development. Results: The symptoms of allergy to foods were demonstrated with a comparable frequency in children with hypogammaglobulinemia and with normal immunoglobulin levels (51% vs. 48%). The most prominent clinical phenotype of children with hypogammaglobulinemia was atopic dermatitis, whereas in children with normal immunoglobulin production, gastrointestinal symptomatology predominated. Uniquely, IgA deficiency showed a statistically significant (p < 0.05) correlation with food allergy and with cutaneous symptomatology. A striking predominance of non-IgE-mediated food allergy was demonstrated in both groups of the children studied, with elevated serum total IgE levels seen more commonly in children with normogammaglobulinemia than in those with hypogammaglobulinemia. Conclusions: The rate of non-IgE mediated allergic sensitization to foods in the population of infants and young children is high and clinically relevant. A selective IgA deficiency should alert physicians to assess affected children with respect to diverse phenotypes of food allergy.

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“…Recent studies found an association between low serum IgE levels and the levels of one or more classes of immunoglobulins (i.e. IgG, IgA and/or IgM) below the reference range for age [10,11]. In line with these reports, a recent review concluded that low IgE levels should be considered as a clinical laboratory 'flag' to screen for antibody deficiency [12].…”

Section: Introductionmentioning

confidence: 92%

Low immunoglobulin E flags two distinct types of immune dysregulation

Elkuch

Greiff

Berger

et al. 2017

Clinical and Experimental Immunology

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1These authors contributed equally to this study. SummaryDuring the last two decades, hyper-immunoglobulin (Ig)E syndromes have been characterized clinically and molecularly in patients with genetically determined primary immunodeficiencies. However, the detection of low IgE levels, defined here as below detection limit in the routine clinical immunology laboratory, has received little attention. We analysed the association of serum IgA, IgM and IgG levels (including IgG subclasses) with low, normal or high serum IgE levels in patients evaluated in a singlecentre out-patient immunodeficiency and allergy clinic. The correlation of serum IgE levels with IgG subclasses depended on the clinical phenotype. In patients with immunodeficiencies, IgE correlated with IgG2 and IgG4 but not with IgG3. In contrast, in patients referred for signs of allergy, IgE correlated with IgG3 but not with IgG2. A low IgE result was associated with low IgG3 and IgG4 in allergy referrals, while immunodeficiency referrals with a low IgE result had significantly lower IgG1, IgG2 and IgG4 levels. Hierarchical clustering of non-IgE immunoglobulin profiles (IgM, IgA, IgG, IgG1-4) validated that non-IgE immunoglobulin levels predict the clinic referral, i.e. phenotype, of low-IgE patients. These results suggesto guide the clinical management of patients with low serum IgE levels.

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Immunoglobulin E deficiency: a forgotten clue pointing to possible immunodeficiency?

Cited by 19 publications

References 14 publications

IgE deficiency may indicate underlying hypogammaglobulinaemia?

IgE deficiency may indicate underlying hypogammaglobulinaemia?

IgA deficiency: a risk factor for food allergy-related atopic dermatitis in infants and young children

Low immunoglobulin E flags two distinct types of immune dysregulation

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