What is the significance of elevated Immunoglobulin E (IgE) in a 6-year-old child?

From the Guidelines

An elevated Immunoglobulin E (IgE) level of 360 in a 6-year-old child suggests an allergic condition and warrants further evaluation by a pediatric allergist for proper diagnosis and management. The child's high IgE level, above 90 IU/mL, indicates an overactive immune response to environmental or food substances, leading to the release of histamine and other inflammatory chemicals that produce allergic symptoms 1.

Key Considerations

• The child should undergo a thorough medical history and physical examination to identify potential allergens and symptoms.
• Common treatments for allergic conditions include antihistamines like cetirizine (5mg daily) or loratadine (5mg daily) for symptom relief.
• If asthma or severe allergies are present, inhaled corticosteroids or leukotriene modifiers might be prescribed.
• Environmental modifications, such as removing allergens from the home, using allergen-proof bedding, and maintaining regular cleaning, are crucial in managing allergic conditions.
• Food allergies may require specific elimination diets based on allergy testing, and the child's diet should be carefully assessed to identify potential allergenic foods.

Allergy Testing and Diagnosis

• The National Institute of Allergy and Infectious Diseases (NIAID) Food Allergy Expert Panel suggests consideration of limited food allergy testing (of cow's milk, eggs, wheat, soy, and peanut) if a child less than 5 years of age has moderate to severe atopic dermatitis and persistent disease despite optimized management and topical therapy 1.
• Tests often performed for evaluation include skin prick testing (SPT) and serum specific IgE level determination, which assess for immediate/type I hypersensitivity reactions.
• Positive skin or blood tests ideally need to be verified by controlled food challenges, and the gold standard test for diagnosing food allergy is a double-blind, placebo-controlled oral food challenge (DBPCFC) 1.

Prognosis and Management

• A high initial level of sIgE against a food is associated with a lower rate of resolution of clinical allergy over time, and most children with food allergy will eventually tolerate milk, egg, soy, and wheat, but far fewer will tolerate tree nuts and peanut 1.
• The child's IgE level and allergy test results should be carefully monitored, and treatment plans should be adjusted accordingly to ensure optimal management of their allergic condition.

From the Research

Elevated Immunoglobulin E (IgE) Levels in Children

• Elevated IgE levels are commonly associated with allergies, but can also be found in other infectious and non-infectious disorders 2, 3
• In children, high IgE levels can indicate atopic diseases such as atopic dermatitis and bronchial asthma, as well as primary immunodeficiencies (PID) 4
• A study of 385 children with suspected immune deficiency found that nearly one-third had elevated serum IgE levels, with most cases having underlying atopy 2
• Another study of 158 children found that PID diagnosis was established in 32 patients, and immunological evaluations were normal in 126 patients 4

Clinical Characteristics and Diagnosis

• Elevated IgE levels can be caused by allergies, infections, and immune conditions, including hyper-IgE syndrome (HIES) 5
• A study of 70 patients with elevated IgE levels found that atopic diseases were the most common cause, and there was a statistically significant association between IgE levels and the severity of eczema 5
• The Hyper-IgE syndrome (HIES) scoring sheet can be used to distinguish PID from other causes of elevated IgE levels 4
• Allergy testing, including serum IgE-specific antibody or skin testing, can help clarify the diagnosis and guide treatment 6

Management and Treatment

• If an inborn error of immunity (IEI) is suspected, a comprehensive immunologic evaluation is required, and genetic testing can help identify the specific genetic abnormality 2
• Pediatricians may use the HIES scoring sheet to determine when to refer a patient to an immunologist for detailed immunologic tests 4
• Treatment for elevated IgE levels depends on the underlying cause, and may include avoiding allergens, immunotherapy, or other medications 6