Indian Journal of Allergy, Asthma and Immunology

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 30  |  Issue : 1  |  Page : 17--21

Estimation of serum immunoglobulin E levels as suggestive indicator of atopy in children having allergic rhinitis


Chetan Meena1, Mohit Poddar2, Bhagwan Sahai Sharma1, Kusum Devpura1, Mamta Meena3,  
1 Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, India
2 Department of Pediatrics, National Institute of Medical Sciences, Jaipur, Rajasthan, India
3 Department of Pediatrics, Deen Dayal Upadhyay Hospital, New Delhi, India

Correspondence Address:
Chetan Meena
5-H-112, Indira Gandhi Nagar, Jagatpura, Jaipur, Rajasthan
India

Abstract

Background: Atopy is the major factor predisposing for the development of allergic airway diseases. Immunoglobulin E (IgE) levels of children having atopy are elevated as compared with nonatopic children. Serum total IgE levels can be utilized as a surrogate marker for the presence of atopy. Objective: To study the presence of atopy by estimation of serum IgE levels in children having allergic rhinitis and to determine the proportion of concomitant allergic conditions in these children. Methods: From May 2012 to April 2013, 134 children aged 6-14 years having allergic rhinitis as diagnosed on the basis of their response to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire were included in the study. Children were screened for concomitant atopic disorders, viz., asthma, atopic eczema, and conjunctivitis on the basis of their response to ISAAC questionnaire. Total serum IgE levels were determined for all subjects. Results: Total IgE levels of study subjects were found to be increased in 114 (85.07%) out of 134 children (cut-off value = 100 IU/mL). Mean serum IgE of the study subjects was 312.18 (95% confidence interval, 253.1-385.1) IU/mL. Children having persistent allergic rhinitis had higher mean IgE levels of 392.18 IU/mL as compared to 199.08 IU/mL (P < 0.01) for children having intermittent allergic rhinitis. One hundred and twenty-two (91.0%) children had concomitant asthma. Persistent allergic rhinitis was found to be significantly associated with family history of smoking (P < 0.01) and family history of atopy (P = 0.02). Conclusion: Significant number of children having allergic rhinitis had increased levels of serum IgE. Hence, total serum IgE can be considered as a supportive and suggestive indicator of atopy in children presenting with allergic rhinitis.



How to cite this article:
Meena C, Poddar M, Sharma BS, Devpura K, Meena M. Estimation of serum immunoglobulin E levels as suggestive indicator of atopy in children having allergic rhinitis.Indian J Allergy Asthma Immunol 2016;30:17-21


How to cite this URL:
Meena C, Poddar M, Sharma BS, Devpura K, Meena M. Estimation of serum immunoglobulin E levels as suggestive indicator of atopy in children having allergic rhinitis. Indian J Allergy Asthma Immunol [serial online] 2016 [cited 2019 Aug 22 ];30:17-21
Available from: http://www.ijaai.in/text.asp?2016/30/1/17/187562


Full Text

 Introduction



Allergic airway diseases cause major illness and disability worldwide regarding their impact on quality of life, loss of productivity, and economic burden. [1] Atopy is the major factor predisposing for the development of allergic airway diseases, and allergic rhinitis is its most common presentation. Allergic rhinitis is diagnosed on the basis of clinical parameters.

Measurement of total serum immunoglobulin E (IgE) levels can serve as a low-cost investigative tool to differentiate between allergic and nonallergic rhinitis which can be further confirmed by skin prick test or allergen-specific IgE.

A prospective, hospital based observational study was carried out in 134 children presenting with allergic rhinitis at General Pediatric Outdoor or Respiratory Clinic at Sir Padampat Mother and Child Health Institute, SMS Medical College, Jaipur, from May 2012 to October 2013. The aims of this study were to explore the usefulness of serum IgE levels as a suggestive marker of atopy in children having allergic rhinitis and to determine the proportion of co-morbid allergic conditions in study subjects.

 METHODS



Study subjects

Children of age 6-14 years having allergic rhinitis diagnosed on the basis of their response to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire [2] were considered as participants for this study. Children having a history of nasal or craniofacial surgery within 30 days; having active infections or history of worm infestations; or having underlying systemic chronic illness were excluded from the study. Informed consent was obtained from all participants before their inclusion in the study. In this study, the presence of increased levels of total serum IgE was taken as positive evidence for the presence of atopy.

Study design

All data in this analysis were collected at the baseline hospital visit. Children presenting with clinical features of allergic rhinitis were diagnosed on the basis of their response to ISAAC questionnaire and subjectively categorized as intermittent and persistent. ISAAC core questionnaire for asthma and eczema and allergic conjunctivitis were used for diagnosis of co-morbidities. Total serum IgE levels were measured at Institute laboratory, SMS Hospital, Jaipur by chemiluminescent assay using ADVIA Centaur® XP immunoassay system.

Statistical analysis

Qualitative data have been expressed in the form of percentage and proportion. Quantitative data has been expressed as geometric mean and standard deviation. The distribution of baseline IgE is positively skewed. Therefore, serum IgE levels have been transformed to a log 10 scale for data analysis and geometric mean, rather than the arithmetic mean, have been used to approximate the normal distribution for statistical inference and modeling. In descriptive analyses, serum IgE levels have been categorized as normal (<100 IU/mL) or raised (>100 IU/mL). Student's t-test has been used to ascertain the significance of differences between mean values of two continuous variables. Chi-square test was performed to analyze differences in proportions of categorical variables between two or more groups. Statistical analyses were performed using STATGRAPHICS Centurion XVI (Version 16.1).

 RESULTS



In this study, 134 children participated having a mean age of 8.48 ± 2.48 years including 39 (29.1%) females and 95 (70.9%) males. Baseline and observed characteristics of the patients are presented in [Table 1].{Table 1}

Increased serum IgE levels (cut-off = 100 IU/mL) were observed in 114 (85.07%) study subjects. The geometric mean of total serum IgE levels was 312.18 (95% confidence interval [CI], 253.1-385.1) IU/mL. Forty-five (33.6%) children had intermittent allergic rhinitis and 89 (66.4%) children were found to have persistent allergic rhinitis. Mean serum IgE levels of children having persistent allergic rhinitis were 392.18 (95% CI, 303.1-507.5) IU/mL which were significantly higher than 199.08 (95% CI, 142.4-278.4) IU/mL for children having intermittent symptoms (P < 0.01).

Among the study subjects, family history of smoking was present in 45 (33.6%) children and a family history of atopy was present in 58 (43.3%) children.

Bronchial asthma was found to be the most common co-morbidity present in 122 (91.04%) children. Other allergic comorbidities were allergic conjunctivitis in 18 (13.43%) children and atopic dermatitis in seven (5.22%) children.

Forty (44.9%) out of 89 children having persistent allergic rhinitis found to have family history of smoking [Figure 1]. In comparison to this, only five (11.1%) out of 45 children having intermittent allergic rhinitis had a family history of smoking. This difference was statistically significant (P < 0.001).{Figure 1}

Forty-five (50.6%) out of 89 children having persistent allergic rhinitis had family history of atopy as compared to 13 (28.9%) out of 45 children having intermittent allergic rhinitis [Figure 2]. This difference was statistically significant (P = 0.02).{Figure 2}

 DISCUSSION



This study was designed to assess the presence of atopy by estimation of serum IgE levels and to determine the frequency of various co-morbidities in children presenting with allergic rhinitis. In this study, we considered serum IgE levels of 100 IU/mL as cutoff level representative of the presence of atopy. Several other studies have reported serum IgE levels of 73-160 IU/mL as a marker for the presence of atopy with varying sensitivity and specificity. [3],[4],[5],[6],[7],[8],[9]

In this study, mean serum IgE levels of studied subjects were 312 IU/mL. This is consistent with the body of evidence from various studies reporting mean IgE levels of children having atopy from 127.5 to 280 IU/mL, which are elevated as compared to other measured, normal, nonatopic population. [10],[11],[12] The reported mean total IgE levels of normal nonatopic population in various studies are 30-66 IU/mL. [13],[14],[15]

In this study, increased serum IgE levels were found in 114 (85.07%) out of 134 children. Other studies have reported increased serum IgE levels in significant proportion of children having atopic manifestations. [16],[17],[18],[19]

Mean IgE levels of children having persistent allergic rhinitis were significantly higher than children having intermittent allergic rhinitis. Although some studies have reported an association between IgE and severity of atopic manifestation, [10],[17],[20],[21],[22] others have not. [23] A longitudinal study in Melbourne, Australia, of asthmatic children studied at 7, 10, and 14 years of age reported mean serum IgE level by grade of disease severity. Results showed higher IgE levels in patients with more severe and persistent asthma compared with those with mild, episodic asthma. [20]

Among subjects having allergic rhinitis as their primary diagnosis, bronchial asthma presented as the most significant comorbidity in 122 (91.04%) children. Eighteen (13.43%) children had allergic conjunctivitis and seven (5.22%) had atopic dermatitis as comorbidity. The atopic phenotype is characterized by high frequencies of comorbid allergic diseases, and allergic rhinitis is most commonly associated with asthma. [24],[25],[26] "Rarely does one hear a wheeze without a sneeze" describes the close relationship between these two entities.

A positive family history of smoking was found to be significantly associated with persistent symptoms of allergic rhinitis. Meta-analysis has reported a significant association of allergic rhinitis and passive smoking. [27] Age is an important effect modifier for the relation between tobacco exposure and risk of allergic diseases. Children, having immature respiratory, nervous, and immune system are vulnerable to health effects of passive smoking. [28]

A positive family history of atopy was significantly associated with persistent symptoms of allergic rhinitis. A genetic background of the atopic disease has been the strongest risk factor for the development of allergic symptoms, irrespective of the varying prevalence and environmental risk factors in different societies. [29],[30]

Serum antigen-specific IgE testing, skin prick test and intradermal skin test are more efficacious to confirm the presence of atopy. These tests are specific for the particular antigen, and either many tests or a combo of tests is required to identify the particular antigen. [31],[32],[33]

In children presenting with allergic rhinitis, higher values of serum total IgE has been found as compared to their normal age and sex-matched counterparts. Hence, we recommend that serum total IgE levels can be used as a marker to differentiate between allergic and nonallergic rhinitis in children presenting with symptoms of allergic rhinitis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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