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Neonatal IgE: a poor screen for atopic disease
R G Ruiz1, D Richards, D M Kemeny
1Department of Child Health, King's College School of Medicine and Dentistry, London, U.K.
Summary
Neonatal screening for atopic disease using serum immunoglobulin E (IgE) is unreliable. Elevated IgE levels at 7 days old showed low sensitivity, making it clinically inapplicable for early detection of allergic conditions.
Area of Science:
- Allergy and Immunology
- Neonatal Screening
- Atopic Disease Diagnosis
Background:
- Elevated neonatal serum immunoglobulin E (IgE) levels have been proposed for atopic disease screening.
- The predictive value of elevated IgE is a key measure of screening test validity.
Purpose of the Study:
- To fully validate neonatal serum IgE testing for atopic disease prediction in infants.
- To compare the reliability of cord blood IgE versus 7-day serum IgE measurements.
Main Methods:
- Prospective assessment of 92 infants with a bi-parental history of atopy for atopic disease in the first year.
- Measurement of total serum IgE using ultrasensitive ELISA on cord blood and 7-day samples.
- Comparison of ELISA results with PRIST and RIA methods, and assessment of IgA for maternal contamination.
Main Results:
- Only 5% of infants had elevated 7-day IgE, despite 49% showing signs of atopic disease.
- The 7-day IgE test demonstrated low sensitivity (7%) and poor positive (60%) and negative (52%) predictive values.
- Elevated neonatal IgE did not effectively identify infants with severe atopic manifestations like eczema and positive skin tests.
Conclusions:
- Serum IgE measurement at 7 days is more reliable than cord blood IgE but lacks clinical utility for screening.
- Neonatal IgE screening is too insensitive to be applied clinically for early detection of atopic diseases.