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Wise et al.

Page 68

Due to the lack of published studies on this topic, an Aggregate Grade of Evidence and evidence based recommendation cannot be provided.

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VIII.F. In vitro testing

VIII.F.1. Serum total IgE (tIgE)— The literature addressing the role of serum tIgE in the evaluation and diagnosis of allergic disease offers conflicting outcomes and divergent opinions. Positive studies, demonstrating a relevant role of measuring tIgE in the evaluation and diagnosis of AR, are listed in Table VIII.F.1-1. Negative studies that report a limited role of measuring tIgE are listed in Table VIII.F.1-2. When taken together, however, this body of literature provides some information that can inform decisions related to the utility of tIgE in directing patient care decisions. Perhaps the strongest statement that can be made on behalf of tIgE is its ability to generally identify patients or populations with atopic or allergic disease. For example, Ando and Shima 892 reported that tIgE is higher in children with AR than in peers with NAR. Marinho et al. 893 found a borderline association between tIgE and current rhinitis. In a retrospective study, Kalpaklioglu and Kavut 894 reported that tIgE is higher in AR than in NAR. Jung et al. 895 conducted a prospective study that showed a tIgE cutoff of 98.7 IU/mL as a strong predictor of AR. Salo et al. 454 performed a cross-sectional study reporting significant associations between tIgE levels and current hay fever in different age classes. Demirjian et al. 896 demonstrated that a tIgE level over 140 IU/mL is suggestive of an atopic cause for patients with clinical symptoms of AR. Hatcher et al. 897 showed that an elevated tIgE in the presence of a negative inhalant-specific IgE screen may suggest the presence of unidentified inhalant allergen sensitization or chronic respiratory inflammatory disease other than AR. Karli et al. 898 reported that tIgE is helpful in confirming the diagnosis but it cannot be recommended for routine use due to its high cost and the time to perform the test. Chung et al. 899 reported that tIgE (cutoff value 150 IU/mL) is a reliable biomarker for AR diagnosis. Jacobs et al. 900 reported a favorable role of measuring tIgE in diagnosing AR, mainly if levels are higher than 100 IU/mL. Li et al. 901 observed that tIgE is higher in AR than in NAR in a retrospective study. Finally, in a 2-year follow-up study, Park et al. 902 showed that in subjects without allergic sensitization at the initial examination, tIgE greater than 17.7 IU/mL was associated with the risk for allergic sensitization, whereas in patients with allergic symptoms but negative SPT results at the initial examination, tIgE greater than 17.4 IU/mL was associated with newly developed allergic sensitization. In contrast, there are 4 studies with negative results in the setting of tIgE and AR/allergy. Satwani et al. 903 reported no association between tIgE level and AR diagnosis. Tu et al. 904 demonstrated an insufficient diagnostic accuracy of tIgE levels to detect allergic diseases regardless of which cutoff value is being used; tIgE was linked more to atopy than directly to symptoms. In the same follow-up study noted above, Park et al. 902 reported that in subjects without allergic sensitization at the initial examination, tIgE less than 17.7 IU/mL was not associated with newly developed allergic nasal symptoms. Finally, Tay et al. 905 conducted a retrospective analysis in patients with high tIgE levels (> 1000 IU/mL) and concluded that the elevated IgE level in AR is of limited clinical/diagnostic value.

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.