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Zhang J, Ni J, Kong W, Liu J, Chen Y. Various clinical manifestations of 223 patients with IgE deficiency in a tertiary hospital in China: A cross-sectional study. Medicine (Baltimore) 2024; 103:e38397. [PMID: 38875431 PMCID: PMC11175936 DOI: 10.1097/md.0000000000038397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024] Open
Abstract
High Immunoglobulin E(IgE) levels associated with hypersensitivity or parasitic infection were well established, but the clinical significance of ultra-low IgE was largely unknown. Previous studies indicated these patients have an elevated risk of cancer, but large-scale epidemiological studies on the prevalence and clinical manifestations of these ultra-low IgE patients are still lacking. A total of 62,997 patients who were admitted to the First Affiliated Hospital of Wenzhou Medical University and had IgE level tests from January 2010 to March 2020 were included. Patients with serum IgE levels < 2 IU/mL were defined to have ultra-low IgE. And the clinical characteristics of these patients were retrospectively analyzed based on electronic medical record system and follow-up. A total of 223 patients (223/62,997, 0.35%) had ultra-low IgE were documented in 62,997 patients who had IgE tests. Among the clinical manifestations of these 223 ultra-low IgE patients, infection ranked first (125/223, 56.05%), following allergic diseases (51/223, 22.87%), hematological disorders (37/223, 16.59%), tumor (27/223, 12.11%) and autoimmune diseases (23/223, 10.31%). To the best of our knowledge, we first reported that the prevalence and clinical characteristics of 223 ultra-low IgE patients in China. The most common comorbidities were infection, allergic diseases, hematological disorders, tumor and autoimmune diseases.
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Affiliation(s)
- Junwu Zhang
- Department of Clinical Laboratory, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Jinyao Ni
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wanzhong Kong
- Department of Clinical Laboratory, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Jinlin Liu
- Department of Clinical Laboratory, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Yanxia Chen
- Department of Rheumatology and Immunology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
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Matricardi PM. The Very Low IgE Producer: Allergology, Genetics, Immunodeficiencies, and Oncology. Biomedicines 2023; 11:biomedicines11051378. [PMID: 37239049 DOI: 10.3390/biomedicines11051378] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/28/2023] Open
Abstract
Opposite to other immunoglobulin (Ig) classes and subclasses, there is no consensus on the definition of normal levels of serum total IgE. However, longitudinal studies on birth cohorts produced growth charts of total IgE levels in helminth-free and never atopic children and defining the normal ranges of total serum IgE concentration at the individual, rather than population, level. Accordingly, very 'low IgE producers' (i.e., children whose tIgE level belong to the lowest percentiles) became atopic while keeping their total IgE levels in a range considered 'normal' if compared to the general age-matched population but 'abnormally high' if projected on the tIgE growth chart against the trajectory of that child's own percentile levels. In 'low IgE producers', the IgE-specific activity, i.e., the ratio between allergen-specific and total IgE, is more important than the absolute specific IgE levels to confirm causality between allergen exposure and allergic symptoms. Patients with allergic rhinitis or peanut anaphylaxis but low or undetectable allergen-specific IgE levels must therefore be reconsidered considering their total IgE levels. Low IgE producers have been also associated with common variable immunodeficiency, lung diseases, and malignancies. A few epidemiological studies have shown a higher risk of malignancies in very low IgE producers, leading to a debated hypothesis proposing a novel, evolutionistic-relevant function for IgE antibodies for antitumor immune surveillance.
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Affiliation(s)
- Paolo Maria Matricardi
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
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Skin Manifestations in Patients with Selective Immunoglobulin E Deficiency. J Clin Med 2022; 11:jcm11226795. [PMID: 36431272 PMCID: PMC9694019 DOI: 10.3390/jcm11226795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022] Open
Abstract
Selective immunoglobulin E deficiency (SIgED) is still an unrecognised primary immunodeficiency despite several observations supporting its existence. This study aimed to describe the skin manifestations associated with SIgED. We retrospectively assessed medical records of patients with SIgED, the diagnosis being based on serum IgE levels ≤2 Uk/L associated with normal serum levels of immunoglobulins G, M, and A. A total of 25 patients (24 female) with SIgED were included in the study. Eleven patients (44%) presented chronic spontaneous urticaria (CSU), five (20%) angioedema always associated with CSU, five erythema (20%), and six eczema (24%). Other, less frequent manifestations were lichen planus, anaphylactoid purpura, thrombocytopenic purpura, bullous pemphigoid, bullous pyoderma gangrenosum, and atypical skin lymphoproliferative infiltrate associated with reactive lymphadenopathy, chronic cholestasis, arthritis, and fibrosing mediastinitis. Fifteen patients (60%) had different types of associated autoimmune diseases, Hashimoto's thyroiditis being the most frequent (n = 5, 20%), followed by arthritis (n = 4, 16%), autoimmune hepatitis, neutropenia, vitiligo, and Sjögren's syndrome (n = 2, 8% each). Five malignancies were diagnosed in four patients (16%). An ultralow IgE serum level may be the only biomarker that reveals the presence of a dysregulated immune system in patients with a broad spectrum of skin manifestations.
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Picado C, de Landazuri IO, Vlagea A, Bobolea I, Arismendi E, Amaro R, Sellarés J, Bartra J, Sanmarti R, Hernandez-Rodriguez J, Mascaró JM, Colmenero J, Vaquero EC, Pascal M. Spectrum of Disease Manifestations in Patients with Selective Immunoglobulin E Deficiency. J Clin Med 2021; 10:jcm10184160. [PMID: 34575269 PMCID: PMC8466644 DOI: 10.3390/jcm10184160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Selective IgE deficiency (SIgED) has been previously evaluated in selected patients from allergy units. This study investigates the effects of SIgED on the entire population in a hospital setting and sought to delineate in detail the clinical aspects of SIgED. METHODS A retrospective study of the data obtained from electronic medical records of 52 adult patients (56% female) with a mean age of 43 years and IgE levels of <2.0 kU/L with normal immunoglobulin (Ig) IgG, IgA, and IgM levels, seen at our hospital, without selection bias, from 2010 to 2019. RESULTS Recurrent upper respiratory infections were recorded in 18 (34.6%) patients, pneumonia was recorded in 16 (30.7%) patients, bronchiectasis was recorded in 16 (30.7%) patients, and asthma was recorded in 10 (19.2%) patients. Eighteen patients (34.6%) suffered autoimmune clinical manifestations either isolated (19%) or combining two or more diseases (15%), Hashimoto's thyroiditis being the most frequent (19%), which was followed by arthritis (10%) and thrombocytopenia and/or neutropenia (5.7%). Other less frequent associations were Graves' disease, primary sclerosing cholangitis, Sjögren's syndrome, and autoimmune hepatitis. Eczematous dermatitis (15.3%), chronic spontaneous urticaria (17.3%), and symptoms of enteropathy (21%) were also highly prevalent. Thirty percent of patients developed malignancies, with non-Hodgkin lymphomas (13.4%) being the most prevalent. CONCLUSIONS The clinical manifestations of SIgED encompass a variety of infectious, non-infectious complications, and malignancy. Since it cannot be ruled out that some type of selection bias occurred in the routine assessment of IgE serum Ievels, prospective studies are required to better characterize SIgED and to determine whether it should be added to the list of antibody deficiencies.
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Affiliation(s)
- César Picado
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Correspondence:
| | - Iñaki Ortiz de Landazuri
- Immunology Department, CDB. Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.O.d.L.); (A.V.)
| | - Alexandru Vlagea
- Immunology Department, CDB. Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.O.d.L.); (A.V.)
| | - Irina Bobolea
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Ebymar Arismendi
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Rosanel Amaro
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Jacobo Sellarés
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Joan Bartra
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
| | - Raimon Sanmarti
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Department of Rheumatology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - José Hernandez-Rodriguez
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - José-Manuel Mascaró
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Department of Dermatology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Jordi Colmenero
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Liver Unit, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigaciones en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
| | - Eva C. Vaquero
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Department of Gastroenterology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Mariona Pascal
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Immunology Department, CDB. Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.O.d.L.); (A.V.)
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Barton JC, Barton JC, Bertoli LF, Acton RT. Factors associated with IgG levels in adults with IgG subclass deficiency. BMC Immunol 2021; 22:53. [PMID: 34372773 PMCID: PMC8353875 DOI: 10.1186/s12865-021-00447-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background Factors associated with IgG levels in adults with IgG subclass deficiency (IgGSD) are incompletely understood. We studied adults with IgGSD with subnormal IgG1 only, subnormal IgG1/IgG3, or subnormal IgG3 only without other subnormal IgG subclasses, IgA, or IgM. We compiled: age; sex; autoimmune condition(s) (AC); atopy; IgG, IgG subclasses, IgA, IgM; IgGsum (IgG1 + IgG2 + IgG3 + IgG4); and D (percentage difference between IgGsum and IgG). We compared attributes of patients with/without subnormal IgG (< 7.00 g/L; subnormal IgG1 subclass groups only) and analyzed IgGsum and IgG relationships. We performed backward stepwise regressions on IgG using independent variables IgG subclasses, age, and sex and on D using independent variables age and sex. Results There were 39 patients with subnormal IgG1 only (89.7% women), 53 with subnormal IgG1/IgG3 (88.7% women), and 115 with subnormal IgG3 only (91.3% women). Fifteen patients (38.5%) and 32 patients (60.4%) in the respective subnormal IgG1 subclass groups had subnormal IgG. Attributes of patients with/without IgG < 7.00 g/L were similar, except that AC prevalence was lower in patients with subnormal IgG1 only and IgG < 7.00 g/L than ≥ 7.00 g/L (p = 0.0484). Mean/median IgG1 and IgG2 were significantly lower in patients with IgG < 7.00 g/L in both subnormal IgG1 subclass groups (p < 0.0001, all comparisons). Regressions on IgG in three subclass groups revealed positive associations with IgG1 and IgG2 (p < 0.0001 each association). Regressions on D revealed no significant association. IgG1 percentages of IgGsum were lower and IgG2 percentages were higher in patients with subnormal IgG1 subclass levels than subnormal IgG3 only (p < 0.0001 all comparisons). Conclusions We conclude that both IgG1 and IgG2 are major determinants of IgG in patients with subnormal IgG1, combined subnormal IgG1/IgG3, or subnormal IgG3 and that in patients with subnormal IgG1 or combined subnormal IgG1/IgG3, median IgG2 levels are significantly lower in those with IgG < 7.00 g/L than those with IgG ≥ 7.00 g/L. Supplementary Information The online version contains supplementary material available at 10.1186/s12865-021-00447-3.
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Affiliation(s)
- James C Barton
- University of Alabama at Birmingham, Birmingham, AL, USA. .,Southern Iron Disorders Center, Birmingham, AL, USA. .,Department of Medicine, Brookwood Medical Center, Birmingham, AL, USA.
| | | | - Luigi F Bertoli
- Southern Iron Disorders Center, Birmingham, AL, USA.,Department of Medicine, Brookwood Medical Center, Birmingham, AL, USA
| | - Ronald T Acton
- Southern Iron Disorders Center, Birmingham, AL, USA.,Department of Microbiology, University of Alabama At Birmingham, Birmingham, AL, USA
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Campisi L, Forster T, Karim MY. Reflex Testing of Immunoglobulins in Patients with Total Serum IgE < 2 kU/L. J Clin Immunol 2018; 38:550-552. [PMID: 29959664 DOI: 10.1007/s10875-018-0526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/19/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Lisa Campisi
- Department of Medicine, Royal Surrey County Hospital, Guildford, UK
| | - Tamara Forster
- Department of Immunology, Berkshire & Surrey Pathology Services, St Peter's Hospital, Chertsey, UK
| | - Mohammed Yousuf Karim
- Department of Immunology, Berkshire & Surrey Pathology Services, St Peter's Hospital, Chertsey, UK.
- Department of Pathology, Sidra Medicine, Doha, Qatar.
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Hypogammaglobulinemia E in 216 adults with IgG subclass deficiency and respiratory tract infections. Ann Allergy Asthma Immunol 2017; 119:292-294. [PMID: 28778661 DOI: 10.1016/j.anai.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/06/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022]
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Elkuch M, Greiff V, Berger CT, Bouchenaki M, Daikeler T, Bircher A, Navarini AA, Heijnen I, Recher M. Low immunoglobulin E flags two distinct types of immune dysregulation. Clin Exp Immunol 2017; 187:345-352. [PMID: 28078662 DOI: 10.1111/cei.12885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 10/20/2022] Open
Abstract
During the last two decades, hyper-immunoglobulin (Ig)E syndromes have been characterized clinically and molecularly in patients with genetically determined primary immunodeficiencies. However, the detection of low IgE levels, defined here as below detection limit in the routine clinical immunology laboratory, has received little attention. We analysed the association of serum IgA, IgM and IgG levels (including IgG subclasses) with low, normal or high serum IgE levels in patients evaluated in a single-centre out-patient immunodeficiency and allergy clinic. The correlation of serum IgE levels with IgG subclasses depended on the clinical phenotype. In patients with immunodeficiencies, IgE correlated with IgG2 and IgG4 but not with IgG3. In contrast, in patients referred for signs of allergy, IgE correlated with IgG3 but not with IgG2. A low IgE result was associated with low IgG3 and IgG4 in allergy referrals, while immunodeficiency referrals with a low IgE result had significantly lower IgG1, IgG2 and IgG4 levels. Hierarchical clustering of non-IgE immunoglobulin profiles (IgM, IgA, IgG, IgG1-4) validated that non-IgE immunoglobulin levels predict the clinic referral, i.e. phenotype, of low-IgE patients. These results suggesto guide the clinical management of patients with low serum IgE levels.
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Affiliation(s)
- M Elkuch
- Immunodeficiency Clinic, Medical Outpatient Unit and Immunodeficiency Laboratory, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - V Greiff
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
| | - C T Berger
- Medical Outpatient Unit and Translational Immunology Laboratory, Department of Biomedicine, Basel, Switzerland
| | - M Bouchenaki
- Division of Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - T Daikeler
- Rheumatology Clinic, University Hospital Basel, Basel, Switzerland
| | - A Bircher
- Allergy and Dermatology Clinic, University Hospital Basel, Basel
| | - A A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - I Heijnen
- Division of Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - M Recher
- Immunodeficiency Clinic, Medical Outpatient Unit and Immunodeficiency Laboratory, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
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