Index > Vol. 89/2009 > Iss. 3/May > pp. 257-261 > Abstract
Clinical Report | Atopy

Total Serum IgE as a Parameter to Differentiate Between Intrinsic and Extrinsic Atopic Dermatitis in Children

doi: 10.2340/00015555-0627

Abstract:

Atopic dermatitis (AD) has been sub-classified into extrinsic and intrinsic types according to the presence or not of allergen-specific IgE antibodies. Although total serum IgE levels are frequently elevated in AD, their
potential to predict allergen-specific IgE (asIgE) has rare ly been studied. We investigated 103 children with AD and suspected allergen-specific sensitization. A thorough clinical examination, a structured medical history and total serum IgE and asIgE measurements were performed. Fifty-three male and 50 female patients, median age 35 months (range 3 months to 17 years), were recruited. Sixty-three percent of patients were asIgE positive, while 37% did not reveal such IgE antibodies; median total serum IgE levels were 224.0 kU/l (14–12,013 kU/l) and 25.2 kU/l (0–4352 kU/l), respectively. Associations of asIgE status with atopic co-morbidity and total serum IgE levels were statistically significant. At a cut-off total serum IgE level of 106 kU/l (sensitivity 68.7%; specificity 92.3%), positive and negative predicted values (93.6% and 64.3%, respectively) were determined. Clinical decision points predictive of positive asIgE results were identified in 90%, 95% and 99% of patients, respectively. Total serum IgE values were significantly associated with the asIgE status of investigated patients. However, these preliminary data warrant further large-scale investigations before total serum IgE levels can be regarded as a clinically useful parameter between patients with extrinsic atopic dermatitis and intrinsic atopic dermatitis.

Authors:

Hagen Ott, Sven Stanzel, Christine Ocklenburg, Hans-Friedrich Merk, Jens Malte Baron and Sylvia Lehmann

Key words:

IgE; children; atopic dermatitis.

References

  1. Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001; 56: 813–824. Link to article
  2. Perkin MR, Strachan DP, Hc W, Lack G, Golding J; ALSPAC Study Team. The predictive value of early life total immunoglobulin E measurement in identifying atopic children in a population-based birth cohort study. Pediatr Allergy Immunol 2006; 17: 118–124. Link to article
  3. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet 1998; 351: 1225–1232. Link to article
  4. Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006; 368: 733–743. Link to article
  5. Park JH, Choi YL, Namkung JH, Kim WS, Lee JH, Park HJ, et al. Characteristics of extrinsic vs. intrinsic atopic dermatitis in infancy: correlations with laboratory variables. Br J Dermatol 2006; 155: 778–783. Link to article
  6. Kusel MM, Holt PG, de Klerk N, Sly PD. Support for 2 variants of eczema. J Allergy Clin Immunol 2005; 116: 1067–1072.
  7. Brenninkmeijer EE, Spuls PI, Legierse CM, Lindeboom R, Smitt JH, Bos JD. Clinical differences between atopic and atopiform dermatitis. J Am Acad Dermatol 2008; 58: 407–414.
  8. Laske N, Niggemann B. Does the severity of atopic dermatitis correlate with serum IgE levels? Pediatr Allergy Immunol 2004; 15: 86–88. Link to article
  9. Hon KL, Lam MC, Leung TF, Wong KY, Chow CM, Fok TF, et al. Are age-specific high serum IgE levels associated with worse symptomatology in children with atopic dermatitis? Int J Dermatol 2007; 46: 1258–1262.
  10. Ohman S, Johansson SG. Allergen-specific IgE in atopic dermatitis. Acta Derm Venereol 1974; 54: 283–290.
  11. Williams HC, Burney PG, Pembroke AC, Hay RJ. Validation of the U. diagnostic criteria for atopic dermatitis in a population setting. Diagnostic Criteria for Atopic Dermatitis Working Party. Br J Dermatol 1996; 135: 12–17. Link to article
  12. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107: 891–896.
  13. Garcia-Ara MC, Boyano-Martinez MT, Dˆ‚az-Pena JM, Martˆ‚n-Muˆ±oz MF, Martˆ‚n-Esteban M. Cow’s milk-specific immunoglobulin E levels as predictors of clinical reactivity in the follow-up of the cow’s milk allergy infants. Clin Exp Allergy 2004; 34: 866–870. Link to article
  14. Wuthrich B, Schmid-Grendelmeier P. The atopic eczema/dermatitis syndrome. Epidemiology, natural course, and immunology of the IgE-associated (“extrinsic”) and the nonallergic (“intrinsic”) AEDS. J Investig Allergol Clin Immunol 2003; 13: 1–5.
  15. Jaakkola MS, Ieromnimon A, Jaakkola JJ. Are atopy and specific IgE to mites and molds important for adult asthma? J Allergy Clin Immunol 2006; 117: 642–648.
  16. Kono M, Mochizuki H, Arakawa H, Kato M, Tokuyama K, Morikawa A. Age-dependent relationship between bronchial hyperresponsiveness to methacholine and total serum IgE level in asthmatic children. Ann Allergy Asthma Immunol 2001; 87: 33–38.
  17. Aral M, Arican O, Gul M, Sasmaz S, Kocturk SA, Kastal U, et al. The relationship between serum levels of total IgE, IL-18, IL-12, IFN-gamma and disease severity in children with atopic dermatitis. Mediators Inflamm 2006; 2006: 73098.
  18. Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M, Eigenmann P, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol 2006; 118: 152–169.
  19. Schmid-Grendelmeier P, Simon D, Simon HU, Akdis CA, Wˆºthrich B. Epidemiology, clinical features, and immunology of the “intrinsic” (non-IgE-mediated) type of atopic dermatitis (constitutional dermatitis). Allergy 2001; 56: 841–849. Link to article
  20. Schˆ§fer T. The impact of allergy on atopic eczema from data from epidemiological studies. Curr Opin Allergy Clin Immunol 2008; 8: 418–422. Link to article
  21. Werfel T, Breuer K. Role of food allergy in atopic dermatitis. Curr Opin Allergy Clin Immunol 2003; 4: 379–385.
  22. Kemp AS. Egg allergy. Pediatr Allergy Immunol 2007; 18: 696–702. Link to article
  23. Kramer U, Lemmen C, Bartusel E, Link E, Ring J, Behrendt H. Current eczema in children is related to Der f 1 exposure but not to Der p 1 exposure. Br J Dermatol 2006; 154: 99–105. Link to article
  24. Hansen SK, Deleuran M, Johnke H, Thestrup-Pedersen K. House dust mite antigen exposure of patients with atopic dermatitis or psoriasis. Acta Derm Venereol 1998; 78: 139–141. Link to article
  25. Celik-Bilgili S, Mehl A, Verstege A, Staden U, Nocon M, Beyer K, et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy 2005; 35: 268–273. Link to article
  26. Ott H, Baron JM, Heise R, Ocklenburg C, Stanzel S, Merk HF, et al. Clinical usefulness of microarray-based IgE detection in children with suspected food allergy. Allergy 2008; 63: 1521–1528. Link to article
  27. Kulig M, Tacke U, Forster J, Edenharter G, Bergmann R, Lau S, et al. Serum IgE levels during the first 6 years of life. J Pediatr 1999; 134: 453–458.
  28. Hamilton RG, Adkinson NF, Jr. Clinical laboratory assessment of IgE-dependent hypersensitivity. J Allergy Clin Immunol 2003; 111: S687–S701.
  29. Potaczek DP, Sanak M, Mastalerz L, Milewski M, Gawlewicz-Mroczka A, Szczeklik A. Genetic polymorphisms of the novel FCERIA gene region: relation to total serum IgE levels. Ann Allergy Asthma Immunol 2007; 98: 500–501.
  30. Weidinger S, Illig T, Baurecht H, Irvine AD, Rodriguez E, Diaz-Lacava, et al. Loss-of function variations within the filaggrin gene predispose for atopic dermatitis with allergic sensitizations. J Allergy Clin Immunol 2006; 118: 214–219.