Total and allergen‐specific IgE levels in serum reflect blood eosinophilia and fractional exhaled nitric oxide concentrations but not pulmonary functions in allergic asthmatic children sensitized to house dust mites

Abstract

Although elevated levels of serum immunoglobulin E (IgE) are considered the hallmark of atopic diseases, their clinical value in evaluating subjects with allergic disorders is under debate. To evaluate possible relationships between serum IgE levels and a variety of clinical parameters, 83 mild asthmatic children [10.98-year-old (2.95)], sensitized to house dust mites (HDM) Dermatophagoides pteronyssinus (Dp) or D. farinae (Df), were enrolled. As compared with normal control reference values detected in our laboratory, children with allergic asthma had higher blood eosinophil counts (expressed both as percentage and as absolute number) and higher fractional exhaled nitric oxide (FeNO) levels but similar values in pulmonary function parameters. In the allergic asthmatic population, serum levels of total, Dp-specific or Df-specific IgE correlated positively with eosinophil counts (Rho > or = 0.30, p < 0.01, each correlation) and FeNO levels (Rho > or = 0.33, p < 0.01, each correlation) but not with pulmonary function parameters (p > 0.1, each correlation). Finally, significant correlations, although moderate, were found in the allergic asthmatic population between eosinophil counts and FeNO levels (Rho > or = 0.42, p < 0.001, each correlation). Thus, in atopic children sensitized to HDM with mild intermittent asthma, IgE levels in blood appear to reflect systemic (blood eosinophils) and organ-specific (FeNO) markers of allergic inflammation but not pulmonary volumes or the degree of airflow limitation.

Determinants of exhaled nitric oxide levels in healthy, nonsmoking African American adults

“…We also determined the relationship of serum factors to FeNO levels. In agreement with prior studies, [16][17][18][19]27 we found that there was a direct correlation of serum total IgE and ECP levels with FeNO levels in our cohort (Table I and Fig E3, A and B, in the Online Repository at www.jacionline.org). We also found a weak direct correlation between serum nitrate levels and FeNO levels (r 2 5 0.0083, P 5 .0499; Table I and Fig E3, C).…”

“…14,15 In patients with asthma and atopy, serum total and allergenspecific IgE levels, serum eosinophil cationic protein (ECP) levels, and peripheral blood eosinophils are all associated with increased FeNO levels. [16][17][18][19] In healthy adult subjects male sex, height, upper respiratory tract infection (URI), and nitrate intake have been associated with increased FeNO levels, [20][21][22][23][24][25][26][27] whereas cigarette smoking 28 and hypertension 29 have been associated with low FeNO levels. There are conflicting reports about whether age is associated with differences in FeNO levels in adults, 20,27 whereas in children there is more consensus that increasing age is associated with higher FeNO levels.…”

Determinants of Exhaled Nitric Oxide Levels (FeNO) in Childhood Atopic Asthma: Evidence for Neonatal Respiratory Distress as a Factor Associated With Low FeNO Levels

“…Conversely, only very high eosinophil counts (>600 cells/mm 3 ) and an elevation of total serum IgE concentrations above 335 kU/L were strongly linked to high FeNO levels. Interestingly, among factors related to the patient history known to influence the natural course and/or the severity of asthma, only the presence of neonatal respiratory distress turned out to be a potential factor associated with low FeNO level in childhood atopic asthma (3,23).…”

“…Different authors have shown that FeNO levels are elevated in childhood allergic asthma and correlated with the degree of allergic sensitization and eosinophilic inflammation (1,3), whereas studies on associations with lung function parameters led to conflicting results. None of these studies explored the link between FeNO lev-els and allergic sensitization or eosinophilia on the basis of a multivariate analysis able to identify potential risk factors.…”

Characterizing wheeze phenotypes to identify endotypes of childhood asthma, and the implications for future management

“…Early studies investigated eosinophilia as a potential biomarker [68][69][70][71][72]. One study showed variations in immune response within seemingly homogeneous IgE-mediated asthma phenotypes [73].…”