Using Serum IgE Antibodies to Predict Esophageal Eosinophilia in Children

Abstract

Objectives Symptoms of eosinophilic esophagitis (EoE) are variable and can be nonspecific. Food-specific serum IgE antibodies are frequently found in EoE patients and are obtained using a widely available blood test. Our objective was to evaluate the ability of food-specific IgE antibodies to predict the presence of esophageal eosinophilia. Methods We reviewed 144 medical records for pediatric patients having esophageal biopsy and serum analysis for IgE antibodies to food (exploratory group). We performed logistic regression using gender and number of positive food-specific IgE tests to develop a model that predicts ≥15 eosinophils/high power field (hpf) in the esophagus. We tested the model using 142 additional patients (validation group). Results The probability of having ≥15 eosinophils/hpf in the esophagus was higher in males and increased with the number of positive food-specific IgE tests from 12% (95% confidence interval [CI] 4.8-26) in females with 0 foods positive to 86% (95% CI71-94) for males with 4 or 5 foods positive. The statistical model using gender and number of positive IgE tests to predict patients having ≥15 eosinophils/hpf showed acceptable discriminative ability (area under the receiver operating characteristic [ROC] curve 0.80). The performance metrics for the model to predict ≥15 eosinophils/hpf in the validation group were similar (area under the ROC curve 0.75). Conclusions Requiring only a blood test and a simple algorithm, analysis for IgE antibodies to food may expedite an esophagogastroduodenoscopy and decrease delays in the diagnosis and treatment of patients with nonspecific gastrointestinal symptoms who have increased eosinophils in the esophagus.

Specific IgG 4 antibodies to cow's milk proteins in pediatric patients with eosinophilic esophagitis

“…Recently, our group has reported that IgE antibodies to food, specifically low- to moderate-titer sIgE to CM, is associated with EoE among children scheduled for esophagoscopy. 12,16,25–27 Here we found that food sIgE levels were detected commonly in sera from the EoE cohort (76%), but interestingly, 36% of control children also had detectable sIgE to milk (Table I). Although mostly of low titer (0.10–2.0 IU/mL), values were greater in children with EoE than control children.…”

Children with eosinophilic esophagitis in real life: 10 years’ experience with a focus on allergic management

“…As for the prick test, the negative predictive value of IgE testing in better than the positive one but concordance with symptoms is low. (19) Several studies showed that patients with low or undetectable IgE could respond to the eviction of incriminated food. Thus, recombinant humanized anti-IgE antibody (Omalizumab) seems ineffective to treat EoE.…”

Allergic components of eosinophilic esophagitis

“…Several investigators have examined testing methods for identifying food allergies in EoE by using either percutaneous skin testing 23, 31, 36–39 or serum specific IgE. 40–43 Alternative methods for measuring food specific IgE including basophil activation test (BAT), Immuno Solid Phase Allergen CHIP (ISAC) have been studied. Potential methods for testing non-IgE methods include IgG4 or atopy patch testing.…”