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Lawrence MG, Palacios-Kibler TV, Workman LJ, Schuyler AJ, Steinke JW, Payne SC, McGowan EC, Patrie J, Fuleihan RL, Sullivan KE, Lugar PL, Hernandez CL, Beakes DE, Verbsky JW, Platts-Mills TAE, Cunningham-Rundles C, Routes JM, Borish L. Low Serum IgE Is a Sensitive and Specific Marker for Common Variable Immunodeficiency (CVID). J Clin Immunol 2018; 38:225-233. [PMID: 29453744 PMCID: PMC5934300 DOI: 10.1007/s10875-018-0476-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/04/2018] [Indexed: 11/26/2022]
Abstract
Although small prior studies have suggested that IgE can be low in common variable immunodeficiency (CVID), the workup for patients with recurrent infections and suspected hypogammaglobulinemia does not include the routine measurement of serum IgE. We sought to test the hypothesis that low/undetectable serum IgE is characteristic of CVID by comparing the frequency of low/undetectable serum IgE in healthy controls and patients with CVID. We measured total serum IgE in a large multi-center cohort of patients with CVID (n = 354) and compared this to large population-based cohorts of children and adults. We further compared IgE levels in patients with CVID to those with other forms of humoral immunodeficiency, and in a subset, measured levels of allergen-specific serum IgE and IgG subclasses. Lastly, we evaluated for the presence of IgE in commercially available immunoglobulin replacement therapy (IgRT) products. An undetectable serum IgE (< 2 IU/ml) occurs in only 3.3% (95% CI, 1.9-5.7%) of the general population. In contrast, an undetectable IgE occurs in 75.6% (95% CI, 65.6-85.7%) of patients with CVID. Conversely, a high IgE (> 180 IU/ml) is very uncommon in CVID (0.3% of patients). IgE is > 2 IU/ml in 91.2% of patients with secondary hypogammaglobulinemia, and thus, an IgE < LLOD is suggestive of a primary humoral immunodeficiency. Allergen-specific IgE is not detectable in 96.5% of patients with CVID. Sufficient quantities of IgE to change the total serum IgE are not contained in IgRT. The IgG1/IgG4 ratio is increased in subjects with low IgE, regardless of whether they are controls or have CVID. These findings support the routine measurement of serum IgE in the workup of patients with hypogammaglobulinemia.
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Affiliation(s)
- Monica G Lawrence
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA.
| | | | - Lisa J Workman
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
| | - Alexander J Schuyler
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
| | - John W Steinke
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
| | - Spencer C Payne
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
- Department of Otolaryngology, University of Virginia, Charlottesville, VA, USA
| | - Emily C McGowan
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Ramsay L Fuleihan
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kathleen E Sullivan
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patricia L Lugar
- Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Camellia L Hernandez
- Division of Allergy-Immunology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Douglas E Beakes
- Division of Allergy-Immunology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - James W Verbsky
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - John M Routes
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Larry Borish
- Department of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22908, USA
- Department of Microbiology, Carter Immunology Center, University of Virginia, Charlottesville, VA, USA
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Paganelli R, Quinti I, D'Offizi GP, Papetti C, Cabello A, Aiuti F. A study of IgE in immunoglobulin preparations for intravenous administration. I. IgE in intravenous IgG. Vox Sang 1986; 51:87-91. [PMID: 3095990 DOI: 10.1111/j.1423-0410.1986.tb00220.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We have studied the IgE content of different lots of commercial intravenous IgG preparations used in our day hospital as replacement therapy for patients with agammaglobulinemia. Two enzymatic methods were used: Phadezym and FAST. The average amounts of IgE detected in Endobulin and Sandoglobulin lots were very high with respect to serum values in the general population. In some lots we found low titers of specific IgE (RAST class 1) to house dust mite, rye grass and cow's milk. We also found in most preparations the presence of IgG anti-IgE which are usually present in sera from atopic patients. Despite a low post-infusion increase of serum IgE and the absence of sensitization or adverse reactions observed, a careful selection of donors with normal IgE levels may need to be recommended to manufacturers in the future.
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