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Kostova P, Papochieva V, Miteva D, Georgieva B, Mileva S, Shahid M, Lukanov T, Petrova G. Elevated IgE Levels-An Allergy or an Underlying Inborn Error of Immunity in Children with Recurrent Infections? Antibodies (Basel) 2023; 12:70. [PMID: 37987248 PMCID: PMC10660463 DOI: 10.3390/antib12040070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
Elevated immunoglobulin E (IgE) is a hallmark of allergic diseases. However, high IgE levels also occur in a number of other infectious and noninfectious diseases. In most cases, elevated IgE levels indicate allergy, eczema, or chronic skin infection. Very high IgE levels are not uncommon in patients with active eczema but more often indicate monogenic atopic disorder or inborn errors of immunity with an atopic phenotype. We conducted a retrospective study of 385 children with suspected immune deficiency referred to the clinic over a 9-year period. Measurement of IgE, IgG, IgA, IgM, and IgG subclasses in blood samples revealed that nearly one-third of the patients had elevated serum IgE levels. Most of the cases with elevated IgE were children with underlying atopy-mainly atopic dermatitis and, to a lesser extent, bronchial asthma-whereas 40.12% (37 children) had no atopy at all. In the most severe cases (with extremely elevated IgE or severe dermatitis), we confirmed genetic mutations for underlying immunodeficiency. Our results indicate that allergic phenotype should not be underestimated and that children with more severe allergic disease should be evaluated for an underlying inborn error of immunity. If inborn error of immunity (IEI) is suspected, a comprehensive immunologic evaluation is required. Genetic testing helps identify the specific genetic abnormality, which provides important insight into the immunopathogenesis of the disease and accurate determination of optimal therapy.
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Affiliation(s)
- Polina Kostova
- Pediatric Department, Medical University Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
- Pediatric Clinic, UMHAT Alexandrovska, 1 Georgi Sofiyski Str., 1431 Sofia, Bulgaria
| | - Vera Papochieva
- Pediatric Clinic, UMHAT Alexandrovska, 1 Georgi Sofiyski Str., 1431 Sofia, Bulgaria
| | - Dimitrinka Miteva
- Pediatric Department, Medical University Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
- Pediatric Clinic, UMHAT Alexandrovska, 1 Georgi Sofiyski Str., 1431 Sofia, Bulgaria
| | - Bilyana Georgieva
- Pediatric Department, Medical University Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
- Pediatric Clinic, UMHAT Alexandrovska, 1 Georgi Sofiyski Str., 1431 Sofia, Bulgaria
| | - Sirma Mileva
- Pediatric Department, Medical University Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
- Pediatric Clinic, UMHAT Alexandrovska, 1 Georgi Sofiyski Str., 1431 Sofia, Bulgaria
| | - Martin Shahid
- Department of Dermatology and Venereology, Medical University Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
- Dermatology Clinic UMHAT Alexandrovska, 1 Georgi Sofiyski Str., 1431 Sofia, Bulgaria
| | - Tsvetelin Lukanov
- Department of Clinical Immunology with Stem Cell Bank, Medical University Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
- Clinic of Immunology, UMHAT Alexandrovska, 1 Georgi Sofiyski Str., 1431 Sofia, Bulgaria
| | - Guergana Petrova
- Pediatric Department, Medical University Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
- Pediatric Clinic, UMHAT Alexandrovska, 1 Georgi Sofiyski Str., 1431 Sofia, Bulgaria
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Yıldız E, Çölkesen F, Arslan S, Evcen R, Sadi Aykan F, Kılınç M. Allergic Diseases as a Clinical Phenotype Marker in Patients with Common Variable <bold>Immunodeficiency</bold>. Int Arch Allergy Immunol 2023; 184:1047-1055. [PMID: 37473738 DOI: 10.1159/000530901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/24/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Patients with common variable immunodeficiency (CVID) have been shown to be more predisposed to develop allergic diseases because of mucosal immune defects and immune dysregulation. The aim of this study was to determine the prevalence, and clinical and laboratory characteristics of various allergic diseases in patients with CVID. METHODS The study included patients aged ≥18 years who were followed up for a diagnosis of CVID. Patients were separated into 5 groups according to the clinical phenotypic characteristics of lymphoproliferation, autoimmunity, gastrointestinal diseases, allergic diseases, and malignancy. Atopic dermatitis (AD), drug hypersensitivity reaction (DHR), allergic rhinitis (AR), and asthma were accepted as allergic diseases. RESULTS The most commonly seen clinical phenotypes were lymphoproliferation in 41 (48.8%) patients and allergic diseases in 31 (37%). AD was determined in 2 (2.4%) patient, DHR in 5 (6%), AR in 7 (8.3%), and asthma in 21 (25%). The delay in diagnosis of patients with allergic disease was determined to be shorter compared to those without allergic disease (p = 0.042). Serum total immunoglobulin E level, CD19+ B cell, switched memory B cell, and natural killer cell counts were determined to be higher in the CVID patients with allergic disease compared to those without (p = 0.007, p = 0.022, p = 0.023, p = 0.017, respectively). CONCLUSION Allergic diseases should be considered as a marker of clinical phenotype in CVID because of the clinical and immunological differences. Early diagnosis and treatment of allergic diseases in patients with CVID can improve quality of life.
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Affiliation(s)
- Eray Yıldız
- Division of Allergy and Immunology, Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Fatih Çölkesen
- Division of Allergy and Immunology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Sevket Arslan
- Division of Allergy and Immunology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Recep Evcen
- Division of Allergy and Immunology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Filiz Sadi Aykan
- Division of Allergy and Immunology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Kılınç
- Division of Allergy and Immunology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Shahrbabaki ZS, Chavoshzadeh Z, Abdollahimajd F, sharafian S, Jamee M, Bondarenko A, Mahdavi T. Skin manifestations in children with inborn errors of immunity in a tertiary care hospital in Iran. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2023. [DOI: 10.1002/cia2.12296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Zahra Salehi Shahrbabaki
- Immunology and Allergy Department, Mofid Children's Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Zahra Chavoshzadeh
- Immunology and Allergy Department, Mofid Children's Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Fahimeh Abdollahimajd
- Skin Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
- Clinical Research Development Unit of Shohada‐e Tajrish Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Samin sharafian
- Immunology and Allergy Department, Mofid Children's Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Mahnaz Jamee
- Pediatric Nephrology Research Center Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Anastasia Bondarenko
- Department of Pediatrics, Immunology, Infectious and Rare Diseases, European Medic School International European Kyiv Kyiv Ukraine
| | - Tolue Mahdavi
- Department of Allergy and Clinical Immunology, Hazrat Rasoul Hospital Iran University of Medical Sciences Tehran Iran
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El-Sayed ZA, El-Ghoneimy DH, Ortega-Martell JA, Radwan N, Aldave JC, Al-Herz W, Al-Nesf MA, Condino-Neto A, Cole T, Eley B, Erwa NH, Espinosa-Padilla S, Faria E, Rosario Filho NA, Fuleihan R, Galal N, Garabedian E, Hintermeyer M, Imai K, Irani C, Kamal E, Kechout N, Klocperk A, Levin M, Milota T, Ouederni M, Paganelli R, Pignata C, Qamar FN, Quinti I, Qureshi S, Radhakrishnan N, Rezaei N, Routes J, Singh S, Siniah S, Abdel-Hakam Taha I, Tanno LK, Van Dort B, Volokha A, Sullivan K. Allergic manifestations of inborn errors of immunity and their impact on the diagnosis: A worldwide study. World Allergy Organ J 2022; 15:100657. [PMID: 35783543 PMCID: PMC9218584 DOI: 10.1016/j.waojou.2022.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Allergies have long been observed in Inborn Errors of Immunity (IEI) and might even be the first presentation resulting in delayed diagnosis or misdiagnosis in some cases. However, data on the prevalence of allergic diseases among IEI patients are limited and contradictory. Objective To provide a worldwide view of allergic diseases, across a broad spectrum of IEI, and their impact on the timely diagnosis of IEI. Methods This is a worldwide study, conceived by the World Allergy Organization (WAO) Inborn Errors of Immunity Committee. A questionnaire was developed and pilot-tested and was sent via email to collect data from 61 immunology centers known to treat pediatric and/or adult IEI patients in 41 countries. In addition, a query was submitted to The United States Immunodeficiency Network (USIDNET) at its website. Results Thirty centers in 23 countries caring for a total 8450 IEI patients responded. The USIDNET dataset included 2332 patients. Data from responders showed that a median (IQR) of 16.3% (10–28.8%) of patients experienced allergic diseases during the course of their IEI as follows: 3.6% (1.3–11.3%) had bronchial asthma, 3.6% (1.9–9.1%) atopic dermatitis, 3.0% (1.0–7.8%) allergic rhinitis, and 1.3% (0.5–3.3%) food allergy. As per the USIDNET data, the frequency of allergy among IEI patients was 68.8% (bronchial asthma in 46.9%). The percentage of IEI patients who presented initially with allergic disorders was 8% (5–25%) and diagnosis delay was reported in 7.5% (0.9–20.6%). Predominantly antibody deficiencies had the highest frequency of allergic disease followed by combined immunodeficiency with a frequency of 40.3% (19.2–62.5%) and 20.0% (10–32%) respectively. As per the data of centers, anaphylaxis occurred in 25/8450 patients (0.3%) whereas per USIDNET dataset, it occurred in 249/2332 (10.6%); drugs and food allergy were the main causes in both datasets. Conclusions This multinational study brings to focus the relation between allergic diseases and IEI. Major allergies do occur in IEI patients but were less frequent than the general population. Initial presentation with allergy could adversely affect the timely diagnosis of IEI. There is a need for policies to raise awareness and educate primary care and other referring specialties on the association of allergic diseases with IEI. This study provides a network among centers for future prospective studies in the field.
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