Patient, clinical characteristics linked to total serum IgE in children with food allergy
Key takeaways:
- Patient characteristics linked to heightened total serum IgE included age, sex and race.
- Clinical characteristics included allergic rhinitis, asthma and eczema.
Researchers have discovered significant links between total serum IgE in children with food allergy and several patient factors, according to results published in The Journal of Allergy and Clinical Immunology: In Practice.
“When the everyday clinician evaluates a total serum IgE level in a patient with food allergy, they should expect it to be elevated in older patients, in males, in [Black/African American patients], in those with multiple other atopic conditions and a higher [number of] food allergies,” Amal H. Assa’ad, MD, associate director and director of clinical services in the division of allergy and immunology at Cincinnati Children’s Hospital Medical Center and professor of pediatrics at the University of Cincinnati, told Healio.
Using FORWARD study data, Assa’ad and colleagues assessed 398 children with food allergy (median age, 3 years; 59.5% boys; 44% Black and/or African American; 56% white and/or European American) to determine how total serum IgE is linked to different characteristics related to the patient, household, environment and community via univariable and multivariable analyses.
Researchers reported significant positive relationships between total serum IgE and several characteristics prior to adjusting for covariables. In terms of patient and clinical factors, these included older age (8 years old; P < .001), Black/African American race (P < .001) male sex (P = .014), multiple food allergies (P < .001) and the comorbidities of allergic rhinitis (P < .001), asthma (P < .001) and eczema (P = .024).
The household and community characteristics with positive links to total serum IgE in the univariable analysis included lower household income (less than $50,000; P = .005), lower caregiver education (less than a bachelor’s degree; P = .005) and higher area deprivation index (ADI; P < .001).
Notably, researchers did not find a positive link between children’s total serum IgE and the environmental characteristic of tobacco smoke exposure.
All patient and clinical characteristics significantly linked to total serum IgE in univariable analysis continued to be found in multivariable models, according to the study.
In a race-, age-, sex- and ADI-adjusted model, researchers observed significantly heightened total serum IgE among children with allergic rhinitis (P = .01), asthma (P < .001) eczema (P = .007) and more food allergies (P < .001).
Using a model that accounted for more covariables (race, age, ADI, allergic rhinitis, asthma, eczema, number of food allergies and tobacco smoke exposure), the study reported that Black/African American children had significantly elevated total serum IgE vs. white/European American children (P < .001). Boys also had greater total serum IgE vs. girls in this model.
Researchers further found that older children aged 5 years had significantly elevated total serum IgE than younger children aged 2 years (P < .001).
“Overall, TsIgE levels increased with age until about 5 years of age and then decreased slightly with age for children with or without allergic rhinitis, smoke exposure or different number of [food allergies],” Assa’ad and colleagues wrote.
According to the study, this pattern differed when considering the presence of asthma and eczema.
“Among children with asthma or eczema, TsIgE levels peaked at around 5 years old and slightly declined afterwards, whereas among children without asthma or eczema, TsIgE levels increased until about 5 years of age and then continued to increase but with a slightly lower slope for children [greater than or equal to] 5 years than [less than] 5 years,” Assa’ad and colleagues wrote.
Additionally, no link between children’s total serum IgE and the environmental characteristic of tobacco smoke exposure was reported in multivariable analysis.
“I expect some future studies will be different in that they will include patients with higher total IgEs in the patient population studied in order to include the full spectrum of patients with food allergy,” Assa’ad told Healio.
“The inclusion and study of all races with a disorder will inform science in its diagnosis and management,” Assa’ad added.
For more information:
Amal H. Assa’ad, MD, can be reached at amal.assaad@cchmc.org.
Perspective
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This was the first longitudinal observational study to describe total serum IgE in Black/African American and white and/or European American in children with food allergies.
There have been previous reports of total IgE levels in various populations, but this work was the first to describe these levels in a racially, geographically and socioeconomically diverse population of pediatric patients.
We use total serum IgE daily for our pediatric patients with atopic conditions such as food allergies, asthma and atopic dermatitis. While labs provide us with normal values for IgE, knowing which populations are likely to have abnormal/elevated levels, and the factors that affect those levels, helps providers make clinical decisions about additional testing as well as therapy.
This report found IgE levels were positively associated with Black/African American race, older age, male sex, lower household income and decreased parental education level, as well as the atopic conditions of asthma, atopic dermatitis and allergic rhinitis. Tobacco smoke exposure was not significantly correlated in this report.
When we evaluate pediatric patient serum testing, knowing which groups are more likely to show elevated IgE levels helps us determine what direction testing should take as well as which therapy options to consider. Total serum IgE is common target of atopic therapy including newer biologic medications. This report adds a significant amount of knowledge to the relatively sparse database of IgE levels in diverse pediatric populations.
Subsequent research following pediatric patients into adolescence and adulthood, along with changes in their atopic conditions, will provide significant help to clinical decision-making and help us provide patients and parents accurate information about expected progress of their atopic conditions.
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