Elevated total serum IgE in nonatopic patients with aspirin-exacerbated respiratory disease

Aspirin-exacerbated respiratory disease (AERD), also known as Samter's triad, is characterized by asthma, recurrent nasal polyps, and by allergic-like reactions to aspirin and other nonsteroidal anti-inflammatory drugs, although it is not a true immunoglobulin E (IgE)-mediated allergy. Atopy, although common in patients with AERD, is not a characteristic of the disease. Recently, we have observed a subgroup of patients with AERD who have no history of atopy but have abnormally elevated total serum IgE, a phenomenon that has been observed in patients with asthma but has not been further explored. We sought to explore this phenomenon of elevated total serum IgE in the absence of atopy in a subset of patients with AERD.

Patients were diagnosed with AERD with an oral aspirin challenge at the Brigham and Women's Hospital Allergy and Clinics. Atopy was defined as a positive test result to at least one of the common aeroallergens. Elevated total serum IgE was defined as IgE of >100 IU/mL.

We present six patients with AERD and elevated total serum IgE in the absence of any clear atopy. Total serum IgE in these patients ranged from 110 to 1760 IU/mL. Mean blood eosinophil levels for these patients were not significantly different from those of the entire cohort of patients with AERD included in the study.

In a subset of patients with AERD, we observed elevated total serum IgE even when atopy was not present. To better understand the disease, the cause and clinical relevance of this phenomenon deserves further exploration.