IgE levels may assist in diagnosing atopic dermatitis complications in children

The measurement of immunoglobulin E levels in children hospitalized for atopic dermatitis exacerbation or infectious complications may assist in diagnosis differentiation, according to a study.

According to study authors Peck Y. Ong, MD, of the clinical immunology allergy division at Children’s Hospital Los Angeles, and Sanmeet Atwal, BS, of Keck School of Medicine at the University of Southern California, Los Angeles, children with AD often face major complications associated with this chronic skin disease, such as infections, itch, psychosocial effects and sleep deprivation.

While antibiotics are an appropriate treatment for infectious complication, using them to treat AD exacerbation is not supported. Despite this, Ong and Atwal found in a previous study that systemic antibiotics were used in 80% of children hospitalized due to AD exacerbation.

“A possible reason why antibiotics are used often in AD exacerbation is likely due to the signs of severe AD exacerbation consisting of erythema, edema, excoriations and serosanguinous oozing, which can be confused with skin infections,” Ong and Atwal wrote. “Therefore, more objective laboratory tests are needed to differentiate AD exacerbation from infectious complications.”

In this retrospective chart review, the authors evaluated the difference in serum IgE levels in children with AD who were hospitalized for AD exacerbation or AD-associated infectious complications.

The chart review was conducted using electronic medical records from children who were hospitalized at Children’s Hospital Los Angeles from January 2003 to December 2020. The study ultimately included 34 subjects (mean age, 59.4 months; mean length of hospital stay, 5.1 days) who were admitted for AD exacerbation and 34 subjects (mean age, 36.7 months; mean length of hospital stay, 10.2 days) who were admitted for infectious complications.

Results showed that the mean serum total immunoglobulin E (IgE) levels were significantly higher in patients with AD exacerbation (9,603 kU/L ± 15,873 kU/L) compared with those who had infectious complications (3167 kU/L ± 5486 kU/L; P = .029). After performing a logistic regression, researchers found that subjects with an age-adjusted IgE level greater than 4 were three-times as likely to have AD exacerbation than infectious complications (OR = 3.429; 95% CI, 1.176-9.994). Further, this difference remained with an age-adjusted IgE of greater than 10 (OR = 2.987; 95% CI, 1.108-8.049).

According to the authors, it is likely that AD inflammation, rather than just skin infection, contributes to the increase in IgE.

“Contrary to previous observations that increased IgE is associated with infection, our current findings show that hospitalized children with an AD exacerbation have significantly higher total serum IgE levels than patients with an infectious complication,” Ong and Atwal wrote. “These findings may have clinical implications in that serum IgE levels may be used in combination with other markers such as [C-reactive protein] or [erythrocyte sedimentation rate] to differentiate between AD exacerbation and infectious complications in future studies.”