Some individuals with clinically insignificant sensitivity to allergens may have measurable levels of IgE antibodies in serum, and results must be interpreted in the clinical context.įalse-positive results for IgE antibodies may occur in patients with markedly elevated serum IgE (>2500 kU/L) due to nonspecific binding to allergen solid phases. Testing for allergen-specific IgE antibodies is not useful in patients previously treated with immunotherapy to determine if residual clinical sensitivity exists, or in patients in whom the medical management does not depend upon identification of allergen specificity. In patients with a high index of suspicion for allergic disease, testing for allergen-specific IgEs may be warranted. Sensitization to inhalant allergens (dust mite, mold, and pollen inhalants) primarily occurs in older children, adolescents, and adults, and usually manifests as respiratory disease (rhinitis and asthma).Īn elevated concentration of total IgE is not diagnostic for allergic disease, and must be interpreted in the clinical context of the patient, including age, gender, travel history, potential allergen exposure, and family history.Ī normal concentration of total IgE does not eliminate the possibility of allergic disease. The allergens chosen for testing often depend upon the age of the patient, history of allergen exposure, season of the year, and clinical manifestations. In vitro serum testing for specific IgE antibodies may provide an indication of the immune response to an allergen that may be associated with allergic disease. In this scenario, testing for the presence of allergen-specific IgEs may provide more information.Ĭlinical manifestations of allergic disease result from activation of mast cells and basophils, which occurs when Fc epsilon RI -bound IgE antibodies interact with allergen. Total IgE measurements have limited utility for diagnostic evaluation of patients with suspected allergic disease. However, increases in the amount of circulating IgE can also be found in various other diseases, including primary immunodeficiencies, infections, inflammatory diseases, and malignancies. Cross-linking of the Fc epsilon RI -bound IgE leads to cellular activation, resulting in immediate release of preformed granular components (histamine and tryptase) and subsequent production of lipid mediators (prostaglandins and leukotrienes) and cytokines (interleukin-4 and interleukin-5).Įlevated concentrations of IgE may occur in the context of allergic disease. Because of this high-affinity interaction, almost all IgE produced by B cells is bound to mast cells or basophils, which explains the low concentration present in circulation. Fc epsilon RI is a high-affinity receptor specific for IgE present at a high density on tissue-resident mast cells and basophils. The function of IgE is also distinct from other immunoglobulins in that it induces activation of mast cells and basophils through the cell-surface receptor Fc epsilon RI. The physiologic role of IgE is not well characterized, although it is thought to be involved in defense against parasites, specifically helminthes. IgE exists as a monomer, and is present in circulation at very low concentrations, approximately 300-fold lower than that of IgG. It is the most recently described immunoglobulin, having first been identified in 1966. ![]() ![]() Immunoglobulin E (IgE) is one of the 5 classes of immunoglobulins, and is defined by the presence of the epsilon heavy chain.
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