ELEVATED total immunoglobulin E (IgE) levels are associated with atopic dermatitis (AD) severity, but neither total nor allergen-specific IgE levels reliably evaluate AD severity or condition, highlighting the need for a combined approach with clinical history.
AD is a chronic inflammatory skin disease frequently associated with allergies. A recent study assessed total IgE (tIgE) and allergen-specific IgE (sIgE) levels to 20 common allergens in 154 patients with AD across 15 hospitals in China from 2019 to 2021. The correlation between clinical food allergy and sIgE results was also examined, alongside the potential utility of IgE as a biomarker for AD severity.
Serum IgE was measured using reverse-enzyme immuno capture testing (REAST), and patients were grouped by gender, age, disease severity, and region. Statistical analysis revealed distinct allergen sensitivities across age groups. Infants and children with AD had significantly higher sIgE frequencies for food allergens such as egg (71%), cow milk (39%), and wheat (32%) (P < 0.01). Conversely, adolescents and adults exhibited higher sIgE levels for inhaled allergens like house dust mites and Dermatophagoides farinae. Male patients showed higher sIgE positivity for wheat and dust mites compared to females. Clinical reports showed discrepancies: seafood, including crab and shrimp, was most often cited as aggravating AD, despite low corresponding sIgE positivity. Only 12% of patients reported clinical food allergy consistent with sIgE results. Total IgE levels correlated with AD severity, with significantly higher levels in severe cases (375 ± 343 IU/mL) than mild (193 ± 239 IU/mL) or moderate (170 ± 202 IU/mL) forms (P < 0.01). Patients with additional allergic diseases had higher tIgE levels than those without (280 ± 286 IU/mL vs 194 ± 248 IU/mL).
These findings highlight that neither tIgE nor sIgE alone can evaluate AD severity. Incorporating clinical history is essential to avoid unnecessary dietary restrictions. The high food allergen sensitivity in infants suggests early allergen introduction as a potential preventive measure against food allergies. Improved understanding of IgE in AD may refine allergy management in clinical practice.
Abigail Craig, EMJ
Reference
Yu X and Li L. A Multi-centre Analysis of Serum IgE Levels in Atopic Dermatitis. Indian J Dermatol. 2024;69(6):486.
