Elevated IgE Levels-An Allergy or an Underlying Inborn Error of Immunity in Children with Recurrent Infections?

Area of Science:

• Immunology
• Genetics
• Pediatrics

Background:

• Elevated immunoglobulin E (IgE) is a key indicator of allergic diseases.
• High IgE levels can also be present in various infectious and noninfectious conditions.
• Extremely high IgE or severe dermatitis may suggest monogenic atopic disorders or inborn errors of immunity (IEI).

Purpose of the Study:

• To investigate the causes of elevated serum IgE levels in children with suspected immune deficiency.
• To determine the prevalence of atopy and inborn errors of immunity in children presenting with high IgE.
• To emphasize the importance of comprehensive immunologic evaluation for severe allergic phenotypes.

Main Methods:

• Retrospective analysis of 385 children with suspected immune deficiency over a 9-year period.
• Measurement of serum IgE, IgG, IgA, IgM, and IgG subclasses.
• Genetic testing for patients with extremely elevated IgE or severe dermatitis.

Main Results:

• Nearly one-third of the studied children exhibited elevated serum IgE levels.
• Most elevated IgE cases were associated with atopy (atopic dermatitis, asthma).
• A significant proportion (40.12%) of children with elevated IgE had no apparent atopy; genetic mutations for IEI were confirmed in severe cases.

Conclusions:

• Elevated IgE in children warrants thorough evaluation, not solely for allergies.
• Children with severe allergic phenotypes or high IgE without atopy should be assessed for inborn errors of immunity.
• Genetic testing is crucial for diagnosing IEI, understanding disease mechanisms, and guiding therapy.