From the Guidelines
Testing immunoglobulins (Ig) is not a primary approach for managing severe atopic dermatitis, as elevated levels are common but do not necessarily guide treatment decisions. The management of severe atopic dermatitis should focus on optimizing skin care, identifying and avoiding triggers, and using topical and systemic therapies as needed 1. According to the most recent guidelines, the use of phototherapy and systemic therapies such as dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib is recommended for severe cases 1.
The limited utility of immunoglobulin testing in managing severe atopic dermatitis is due to the complex pathophysiology of the disease, which involves skin barrier dysfunction, immune dysregulation, and environmental factors beyond just IgE-mediated responses. While targeted allergen testing may be helpful in specific situations where certain allergens are suspected to trigger flares, routine testing of total IgE or specific IgE antibodies is not recommended as a primary approach for managing atopic dermatitis 1.
Key considerations in managing severe atopic dermatitis include:
- Optimizing skin care with regular emollients
- Identifying and avoiding triggers
- Using topical anti-inflammatory treatments for acute flares and maintenance
- Considering systemic therapies for refractory cases Treatment decisions should be guided by clinical severity, impact on quality of life, and response to previous therapies rather than immunoglobulin levels 1.
From the FDA Drug Label
The provided drug label does not mention testing immunoglobulins (Ig) in the context of managing severe atopic dermatitis (eczema).
The FDA drug label does not answer the question.
From the Research
Testing Immunoglobulins in Severe Eczema
- Testing immunoglobulins can be relevant in managing severe atopic dermatitis (eczema), as it may help identify underlying immunological abnormalities or guide treatment decisions 2, 3, 4, 5, 6.
- Elevated immunoglobulin E (IgE) levels are commonly found in patients with severe eczema, and testing for IgE can aid in diagnosing and managing the condition 3, 4, 5.
- However, the clinical presentation of severe eczema can be similar to that of other genodermatoses, making differential diagnosis challenging 4.
- Immunoglobulin-associated eczema can occur with various immunoglobulin types, and recurrence is frequent even after switching the immunoglobulin type 2.
- Treatment options for severe eczema include high-dose intravenous immunoglobulin (IVIG) and oral cyclosporine, with varying degrees of efficacy 6.
- Studies have shown that dupilumab can be effective in controlling severe eczema in patients with elevated IgE levels and recurrent skin infections 3.
- Parameters of humoral and cellular immunity, including IgE levels and response to immunization, can provide valuable information in managing severe eczema 5.