Yu Xin, Li Linfeng
From the Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Indian J Dermatol. 2024 Nov-Dec;69(6):486. doi: 10.4103/ijd.ijd_151_24. Epub 2024 Oct 29.
To assess the characteristics of total immunoglobulin E (IgE) and allergen-specific IgE (sIgE) to 20 common allergens in 154 patients with atopic dermatitis (AD). To assess the correlation of clinical food allergy with positive food allergens' sIgE results. We further discuss the significance of IgE as a potential biomarker for AD disease severity.
A total of 154 AD patients were collected from 15 hospitals nationwide in China from 2019 to 2021. Serum IgE was measured using reverse-enzyme immuno capture test (REAST). Patients were required to have at least one positive sIgE (N ≥ 0.35 IU/mL). Patients were divided into groups according to gender, age, disease severity, and region. SPSS 26.0 software was used for statistical analysis.
Compared with adolescent and adult, AD in infancy and childhood showed significantly higher frequencies of positive sIgE to food allergens, including egg, cow milk, and wheat (P < 0.01). However, adolescent and adult AD showed significantly higher frequencies of positive sIgE to inhaled allergens, dermatophagoides farinae, and house dust mite. In addition, sIgE in different sexes were different. Compared with women, men showed higher frequencies of positive allergen-specific IgE level to wheat, dermatophagoides farinae, and house dust mite. The most common food allergens with elevated sIgE levels were egg (71%), cow milk (39%) and wheat (32%). However, AD patients reported seafood, including crab, shrimp, and fish, as the most frequent food allergens which aggravate their disease in their daily life. Only 18 (12%) patients reported definite correlation of clinical practice with positive food allergens' IgE results. Among 154 sIgE-positive patients, 99 patients had an increase of total IgE (≥60 IU/ml). TotalIgE (tIgE) levels were significantly different between mild (193 ± 239 IU/mL), moderate (170 ± 202 IU/mL), and severe (375 ± 343 IU/mL) forms of AD patients (P < 0.01). AD patients with accompanied allergic diseases showed significantly higher tIgE levels than those without accompanied allergic symptoms (280 ± 286 IU/mL vs 194 ± 248 IU/mL).
Neither sIgE nor tIgE levels can be used to evaluate the condition or severity of AD. AD patients with accompanied allergic diseases showed significantly higher tIgE levels than those without accompanied allergic symptoms. Infantile AD patients are more allergic to food, while adolescents and adults are more allergic to environmental antigens. IgE tests must be interpreted by combining with clinical history to avoid unnecessary food avoidance. Early food allergen introduction for infants may be promising for the prevention of food allergies.
评估154例特应性皮炎（AD）患者的总免疫球蛋白E（IgE）及针对20种常见变应原的变应原特异性IgE（sIgE）特征。评估临床食物过敏与食物变应原sIgE阳性结果的相关性。我们进一步探讨IgE作为AD疾病严重程度潜在生物标志物的意义。
2019年至2021年从全国15家医院收集了154例AD患者。采用反向酶免疫捕获试验（REAST）检测血清IgE。要求患者至少有一项sIgE阳性（N≥0.35 IU/mL）。根据性别、年龄、疾病严重程度和地区对患者进行分组。使用SPSS 26.0软件进行统计分析。
与青少年和成人相比，婴儿期和儿童期AD患者对食物变应原（包括鸡蛋、牛奶和小麦）的sIgE阳性频率显著更高（P<0.01）。然而，青少年和成人AD患者对吸入性变应原、粉尘螨和屋尘螨的sIgE阳性频率显著更高。此外，不同性别的sIgE存在差异。与女性相比，男性对小麦、粉尘螨和屋尘螨的变应原特异性IgE水平阳性频率更高。sIgE水平升高最常见的食物变应原是鸡蛋（71%）、牛奶（39%）和小麦（32%）。然而，AD患者报告海鲜（包括蟹、虾和鱼）是日常生活中最常使病情加重的食物变应原。只有18例（12%）患者报告临床实践与食物变应原IgE阳性结果有明确相关性。在154例sIgE阳性患者中，99例患者的总IgE升高（≥60 IU/ml）。轻度（193±239 IU/mL）、中度（170±202 IU/mL）和重度（375±343 IU/mL）AD患者的总IgE（tIgE）水平有显著差异（P<0.01）。伴有过敏性疾病的AD患者的tIgE水平显著高于无伴发过敏症状的患者（280±286 IU/mL对194±248 IU/mL）。
sIgE和tIgE水平均不能用于评估AD的病情或严重程度。伴有过敏性疾病的AD患者的tIgE水平显著高于无伴发过敏症状的患者。婴儿期AD患者对食物更过敏，而青少年和成人对环境抗原更过敏。IgE检测必须结合临床病史进行解读，以避免不必要的食物回避。婴儿早期引入食物变应原可能对预防食物过敏有前景。
