Agress Ariela, Oprea Yasmine, Roy Shusmita, Strauch Carolyn, Rosenstreich David, Ferastraoaru Denisa
Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
J Allergy Clin Immunol Pract. 2024 Jan;12(1):185-194. doi: 10.1016/j.jaip.2023.10.026. Epub 2023 Oct 19.
Studies show that IgE-deficient patients (IgE <2.5 kU/L) have a high prevalence of malignancy, but relevant clinical and laboratory characteristics associated with this susceptibility have never been well characterized.
To evaluate if there is an association between a malignancy diagnosis and other immunological parameters (atopy or other immune abnormalities) in IgE-deficient patients.
We retrospectively analyzed medical records of 408 IgE-deficient adults seen at our institution between 2005 and 2020.
A malignancy diagnosis was found in 23.5% (96 of 408) of IgE-deficient patients. Among those who had allergy skin testing performed for allergic rhinitis-like symptoms, the nonatopic IgE-deficient patients (negative environmental skin tests) were more likely to have a malignancy diagnosis than the atopic group (odds ratio [OR] = 4.36, 95% confidence interval [CI]: 1.11-17.13, P = .03). The IgE-deficient individuals with an additional non-common variable immunodeficiency (non-CVID) humoral abnormality (n = 75; with low IgG, IgA, or IgM without meeting criteria for CVID) were more likely to have a malignancy diagnosis than those with only a selective IgE deficiency (n = 134; with normal IgA, IgM, and IgG) (OR = 2.79, 95% CI: 1.37-5.68, P = .005). Among the IgE-deficient patients, certain less well-defined immune abnormalities such as IgM deficiency (OR = 2.46, 95% CI: 1.13-5.36, P = .02), IgG2 deficiency (OR = 10.14, 95% CI: 1.9-54.1, P = .007), and CD4 lymphopenia (OR = 7.81, 95% CI: 2.21-27.63, P = .001) were associated with higher malignancy odds than those without these abnormalities.
The odds of a malignancy diagnosis are not shared equally by all IgE-deficient patients. Prospective studies are needed to determine the utility of performing skin testing and measuring additional immunological parameters in assessing the long-term malignancy risk in IgE-deficient patients.
研究表明，IgE 缺乏患者（IgE<2.5 kU/L）恶性肿瘤患病率较高，但与此易感性相关的临床和实验室特征尚未得到充分描述。
评估 IgE 缺乏患者的恶性肿瘤诊断与其他免疫参数（特应性或其他免疫异常）之间是否存在关联。
我们回顾性分析了 2005 年至 2020 年期间在本机构就诊的 408 例 IgE 缺乏成年患者的病历。
在 408 例 IgE 缺乏患者中，23.5%（96 例）被诊断为恶性肿瘤。在因类似过敏性鼻炎症状进行过敏皮肤试验的患者中，非特应性 IgE 缺乏患者（环境皮肤试验阴性）比特应性组更有可能被诊断为恶性肿瘤（比值比[OR]=4.36，95%置信区间[CI]：1.11-17.13，P=.03）。伴有额外非常见可变免疫缺陷（非 CVID）体液异常（n=75；IgG、IgA 或 IgM 低但不符合 CVID 标准）的 IgE 缺乏个体比仅选择性 IgE 缺乏（n=134；IgA、IgM 和 IgG 正常）的个体更有可能被诊断为恶性肿瘤（OR=2.79，95%CI：1.37-5.68，P=.005）。在 IgE 缺乏患者中，某些定义不太明确的免疫异常，如 IgM 缺乏（OR=2.46，95%CI：1.13-5.36，P=.02）、IgG2 缺乏（OR=10.14，95%CI：1.9-54.1，P=.007）和 CD4 淋巴细胞减少（OR=7.81，95%CI：2.21-27.63，P=.001）与无这些异常的患者相比，患恶性肿瘤的几率更高。
并非所有 IgE缺乏患者患恶性肿瘤的几率相同。需要进行前瞻性研究，以确定进行皮肤试验和测量其他免疫参数在评估 IgE 缺乏患者长期恶性肿瘤风险中的效用。
