Background: Immunoglobulin E (IgE) plays an important role in asthma, but a few patients exhibit extremely high levels of serum total IgE. Objective: This study aimed to investigate the profiles of comorbidity and/or complications, severity, and sensitizations in patients with asthma and with a total IgE level > 1000 kU/L. Methods: We retrospectively analyzed 170 patients with asthma and with total IgE levels of >1000 kU/L from the inpatient data base. Available information, including age, gender, body mass index, diagnosis, results of routine blood tests, pulmonary function, fractional exhaled nitric oxide, induced sputum (if any), IgE (both total and specific) tests and medication records were analyzed. Results: In the study subjects, >80% were adults, and the average total IgE level was median (interquartile range) 1438 kU/L (1181-2255 kU/L). Approximately 15% of the subjects had at least one comorbidity and/or complication, and 78.82% of the subjects were positive for at least one allergen. Airway infections (44.71%) and rhinosinusitis (41.18%) accounted for the two most common conditions despite age groups. Total IgE levels did not differ among the subjects with different conditions. Overall, mites had the highest positive rate (59.4%). Serum total IgE levels were positively correlated with house-dust mite specific IgE (sIgE) levels (r = 0.23; p < 0.05), peripheral blood eosinophil counts (r = 0.21; p < 0.01), and the number of confirmed sIgE positivity (r = 0.19; p < 0.01), and optimal scaling analysis showed that asthma severity was associated with Aspergillus fumigatus sIgE levels. Conclusion: In the subjects with asthma and with a total IgE level of >1000 kU/L, the two most common conditions were airway infections and rhinosinusitis, despite sensitization. A. fumigatus sIgE levels were closely associated with total IgE levels and asthma severity. OT COP
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its economicburdenisstillrising.A1–18%ofthepopulationindi1,ffe2NAllergicarentcountOsthmaisries, and Tinpatienindicated tswithasthmawhoareatopicandthosewhothatelevated serumtotalIgElevelscouldoccur the most common phenotype, and type 2 inflammation are nonatopic, and elevated serum total IgE levels were is considered to be the predominant immune response associated with the risk of asthma as well as with airway against the allergens encountered, which can generate hyperresponsiveness.3–5 However, the correlation immunoglobulin E (IgE). In fact, most cases of asthma at-between the IgE level and asthma severity is controver-tribute to IgE-mediated reaction, and the increased levels sial. The study by Borish et al.6 found that children with of total and specific IgE (sIgE) are involved in the onset severe asthma had a high IgE level, whereas another study, by Davila et al.,7 did not find a significant associa-Fromthe 1NationalDO Respiratory Medical Center, National Clinical Research Center tion between the total IgE levels and disease severity. for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou This could be affected by several factors, such as poly-2InstituteofRespiratoryHealth,TheFirstAffiliatedHospitalofGuangzhouMedical sensitization, nonallergenic factors (infection), and per-Macau,Taipa,Macau,ChinaUniversity,Guangzhou,China; and Faculty of Health Sciences, University of sistent inflammation caused by allergens.8 Despite this, This study was funded by the National Natural Science Foundation of China (Project anti-IgE treatment has been applied in clinical practice 81871736), Guangzhou Science and Technology Foundation (202102010327), for some cases of patients with poorly controlled moder-G.WuandH.HucontributedequallytothisworkSKLRD(Z–2022–09),NationalNaturalScienceFoundationofChina(81871736) ate-to-severe asthma to improve asthma-related symp-The authors have no conflicts of interest to declare pertaining to this article toms and reduce severe exacerbations.9 Supplementaldataavailableatwww.IngentaConnect.com A small proportion of patients exhibit extremely Immunology,StateKeyLaboratoryofRespiratoryDisease,FirstAffiliatedHospitalofAddresscorrespondencetoBaoqingSun,M.D.,DepartmentofAllergyandClinical high levels of total IgE. Conditions such as atopic der-Guangzhou Medical University, 151 Yanjiangxi Rd., Guangzhou 510120, matitis, helminthic infection, and rare primary immu-E-mailaddress:email@example.comGuangdong,China nodeficiencies can lead to markedly upregulated total Copyright© 2022,OceanSidePublications,Inc.,U.S.A. IgE levels.10 Also, some of these patients with sensiti-zation of Aspergillus fumigatus might develop allergic
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ASJC Scopus subject areas
- Immunology and Allergy
- Pulmonary and Respiratory Medicine