|Year : 2020 | Volume
| Issue : 2 | Page : 63-67
Allergic sensitization in nasobronchial allergy patients and its correlation with total immunoglobulin E level
V Kumar1, Deependra Kumar Rai2, H Shekhar2
1 Dhanwantri Allergy and Asthma Clinic, Motihari, AIIMS, Patna, Bihar, India
2 Department of Pulmonary Medicine, AIIMS, Patna, Bihar, India
|Date of Submission||17-Feb-2020|
|Date of Acceptance||10-Jun-2020|
|Date of Web Publication||20-Nov-2020|
Dr. Deependra Kumar Rai
Department of Pulmonary Medicine, AIIMS, Patna, Bihar
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Bronchial asthma (BA) and allergic rhinitis (AR) are immunoglobulin (Ig) E-mediated hypersensitivity phenomena. The objective of the study is to assess the association between total serum IgE level and skin prick test (SPT) in Indian patients who presented with different nasobronchial allergy symptoms.
MATERIALS AND METHODS: This was an observational prospective study conducted in the Allergy and Asthma Clinic, Motihari, Bihar. A total of 183 patients diagnosed as BA and AR undergo SPT against different allergens between January 2017 and July 2018. Serum total IgE was measured in all patients. All statistical analyses were performed using statistical software SPSS version 20 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered statistically significant.
RESULTS: The study patients included 95 males and 88 females (total 183) with a mean age of 27.15 ± 12.64 years. SPT was positive in 99 out of 183 (54.09%) study patients. BA and AR were associated with skin sensitization in 30.60% and 15.30% of patients, respectively, while 54.09% of patients were associated with both AR and asthma. Forty-four out of 99 (44.44%) patients were sensitized to single allergen, while 40.40% and 15.15% of patients were sensitized to 2–5 allergens and >5 allergens, respectively. Except 11 patients, all the study patients had high total IgE level (>150 IU/ml). More than half of the study patients (51.36%) were associated with more than 1000 serum total IgE level. Total IgE level was not affected with the number of allergen sensitization. SPT-positive patients had higher IgE value than SPT-negative patients but statistically not significant (P > 0.05), and there was also poor correlation between SPT result and serum total IgE level (r = 0.102).
CONCLUSION: SPT should be performed in all clinical allergic patients irrespective of serum total IgE level.
Keywords: Asthma, serum total immunoglobulin E, skin prick test
|How to cite this article:|
Kumar V, Rai DK, Shekhar H. Allergic sensitization in nasobronchial allergy patients and its correlation with total immunoglobulin E level. Indian J Allergy Asthma Immunol 2020;34:63-7
|How to cite this URL:|
Kumar V, Rai DK, Shekhar H. Allergic sensitization in nasobronchial allergy patients and its correlation with total immunoglobulin E level. Indian J Allergy Asthma Immunol [serial online] 2020 [cited 2021 Mar 1];34:63-7. Available from: https://www.ijaai.in/text.asp?2020/34/2/63/300927
| Introduction|| |
Allergy occur when immune substances reacts to a foreign substance, like pollen, pet dander or a food etc, that normally does not cause a harm in most person. In response to this, the immune system produces antibodies which bind to the allergen and protect our body.
Bronchial asthma (BA) and allergic rhinitis (AR) are immunoglobulin (IgE)E-mediated hypersensitivity phenomena often associated with sinusitis or other comorbidities such as conjunctivitis and atopic dermatitis.,, Total serum IgE estimation and skin prick testing are commonly available tools for the evaluation of allergic patients. There are various studies ,, which show a strong association between total serum IgE levels, skin test reactivity to different allergens, and allergy prevalence. However elevated total IgE may be due to nonallergic condition such as parasitic infection. We also do not have a specific cutoff value for total IgE that really discriminates patients with allergic disease from those without, and there is considerable overlap.,,
IgE has been considered the most important biological target in the treatment of allergy and asthma, with many investigators trying to interfere with its production or its function in the immune system. This is supported by the success of the anti-IgE monoclonal antibody in the treatment of allergy and asthma. This study was conducted with hypothesis that patients with skin prick test (SPT) positivity have high total IgE and negative SPT patients should have a normal IgE.
Objective of the study
The objective was to assess the association between total serum IgE level and SPT in Indian patients who presented with different nasobronchial allergy symptoms.
| Materials and Methods|| |
This was an observational prospective study conducted in the Allergy and Asthma Clinic, Motihari, Bihar. A total of 183 patients diagnosed as BA and AR underwent SPT against different allergens between January 2017 and July 2018. The diagnosis of BA and AR was made according to the Global Initiative for Asthma and AR in Allergic rhinitis guideline respectively.
- Patients who have been diagnosed as AR, asthma or both and
- Patients who have a history of atopy (Urticaria, eczema, rhinitis, early onset [<12 years]).
- Age > 45 years
- Patients with a history of tuberculosis, diabetes mellitus, hypertension, endocrine disease, or coronary artery disease were excluded from the study
- Pregnant patients were also excluded from the study.
All the sociodemographic and clinical details such as cough, cold, breathlessness, and wheeze were recorded in a specific proforma designed for the study. All the patients were subjected to complete blood count, serum total IgE level (measured by enzyme-linked immunosorbent assay method using commercially available kits), chest radiograph, and sputum test as required.
A written informed consent was obtained from the patients before performing SPT. Skin prick test performed with total 33 standarized allergen (Allergopharma) including (2 mites, 13 types of pollens, 5 types of fungi, 1 types of animal dander, and 12 food allergens) and two control of cold saline and histamine. Patients were counseled to stop drugs interfering with SPT according to the guidelines to achieve an appropriate diagnosis. Drop of each allergen was placed 3 cm apart and then was pricked with a lancet. Buffer saline will be used as a negative control, while histamine acid phosphate (1 mg/ml) as a positive control. The wheel diameter was measured after 15–20 min and reported in “mm.” A skin reaction of ≥3 mm than that produced by the negative control on the SPT was considered as a positive reaction.
Numerical and categorical data were compared between groups using the Student's t-test and Chi-squared-test as appropriate. A point-biserial correlation was used to measure the strength and direction of the association that exists between one continuous variable and one dichotomous variable. All statistical analyses were performed using statistical software SPSS version 20 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered statistically significant.
| Results|| |
The study patients included 95 males and 88 females with a mean age of 27.15 ± 12.64 years. Among the 183 study patients, 99 (54.09%) patients were diagnosed as BA with AR, 56 (30.60%) with BA alone, and 28 (15.30%) with AR. SPT was positive in 99 (54.09) patients. More than half of the study patients (51.36%) were associated with more than 1000 serum total IgE level. The baseline characteristics of the study patients are summarized in [Table 1]. SPT was performed with five categories of allergens (mites, fungus, pollen, animal, and food). Among the 183 study patients, 66 (66.66%) patients were found sensitive to single allergen category, whereas sensitization to two or more than two categories of allergen was found in 19 (19.19%) and 14 (14.14%) patients, respectively. Sensitization with mold was associated with the highest total IgE level (1174.25 ± 665.75) followed by house dust mite, food, and pollen [Table 2]. The total number of allergen positivity per patients was found 3.31 for BA with AR, 2.97 for BA, and 1.63 for AR. Total IgE level did not significantly differ with the number of allergen [Table 3] and [Table 4]. There was no correlation between total IgE and SPT positivity (P > 0.05) (r = 0.102) [Table 5].
|Table 2: Relation between total IgE and allergen sensitization in the study patients|
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|Table 3: Total allergen positivity in different nasobronchial disease and total immunoglobulin E|
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|Table 4: Serum total immunoglobulin E according to the number of allergen sensitization|
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|Table 5: Comparison between skin prick test-positive and skin prick test-negative patients|
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| Discussion|| |
A proper history and physical examination are most important factors for the diagnosis of allergic disorder. Preclinical evaluation and different tests are generally performed to confirm the diagnosis and identifying potentially important environmental allergens. Hence, out of 183 patients, 99 (54.09%) patients were diagnosed as BA with AR, 56 (30.60%) with BA alone, and 28 (15.30%) with AR. Other studies , have different prevalence of these three nasobronchial allergy disease. SPT was positive in 99 (54.09%) patients, which is lower in compare to previous studies , which showed 87.5 and 90.1% respectively and the region could be more standardized allergen used in this study. BA and AR were associated with allergen sensitization in 30.60% and 15.30%, respectively, while 54.09% in patients with both AR and asthma. Forty-four out of 99 (44.44%) patients were sensitized to single allergen, whereas 40.44% and 15.15% of the patients were sensitized to 2-5 allergens and <5 allergens, respectively. Atopy is defined as a genetic predisposition to produce IgE against common environmental aeroallergens and that about 80% of people with asthma are atopic, compared with 30% of the general population. Many physicians perform SPT only in patients with high total IgE, and so this study was basically designed to assess the correlation between allergen sensitization in nasobronchial allergy patients and their total IgE level. Except 11 patients, all the study patients had a high total IgE level (>150 IU/ml). More than half of the study patients (51.36%) were associated with more than 1000 serum total IgE level. The total IgE levels were not only elevated in allergic disorders such as atopic eczema, allergic asthma, and allergic bronchopulmonary aspergillosis, but also in parasitic diseases such as invasive heleminthiasis. The high level of IgE in our study could be due to higher incidence of helmonthic infection and higher air pollution. Our hypothesis was that patients with positive SPT should have high total IgE value compared to negative SPT, but we found higher value in both SPT positive and negative patients although slightly higher level was observed in SPT-positive patients but statistically not significant (P < 0.05) [Figure 1]. We also compare it disease wise, which was not found statistically significant [Table 5]. We performed SPT with mainly five categories of allergen such as mites, fungus, animal, food, and pollen. Serum total IgE level was found highest in mold-sensitized individuals followed by individuals sensitized with food, mite, pollen, and least with those with animals. This study also shows that patients with multiple allergen (more than one category allergen) sensitization did not had higher total IgE value compared to those with single category allergen sensitization [Table 2]. This finding was different when compared to a older study, which shows higher IgE level as sensitization to number of allergen inceeases., Total 295 SPT reaction were found in 183 study patients. The number of allergen positivity per patients was found highest for patients with both AR and asthma patients (3.31), followed by BA (2.97) and AR (1.63), but, again here also, the total IgE was not significantly different in the three groups. We used biserial correlation statistical method to know any association between SPT result and serum total IgE level, and this study shows poor correlation (r = 0.102). Another study , also shows poor correlation between total IgE and SPT.
|Figure 1: Relation variables of immunoglobulin E level and skin prick test positivity (higher proportion of skin prick test-negative patients with elevated serum total immunoglobulin E <500 (19.04% vs. 18.18%) and similarly for serum level of 500–1000 were higher in skin prick test-negative patients than skin prick test-positive patients (28.57% vs. 27.27%) while serum immunoglobulin E more than 1000 IU/ml were higher in skin prick test-positive patients than skin prick test-negative patients (54.44% vs. 52.38%). Number on Y-axis represents proportion|
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The study has certain limitations. We analyzed only 20% of asthma patients who agree for SPT or fulfil inclusion criteria, so generalizing the result may not be appropriate unless you take all consecutive patients. As the study center is a referral center, most of the patients had longer duration of disease and poor control of asthma; this could be a region for high total IgE. We have not assessed other factor such as parasitic infection, viral infection, or air pollution, which can lead to high IgE. As the study was performed in a private hospital located in the north of Bihar, the result cannot be generalized.
| Conclusion|| |
This study shows a poor correlation between SPT and serum total IgE level. Serum total IgE was not significantly different in patients with single or multiple allergen sensitization. SPT should be performed in all clinical allergic patients irrespective of serum total IgE level.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Cazzola M, Segreti A, Calzetta L, Rogliani P. Comorbidities of asthma: Current knowledge and future research needs. Curr Opin Pulm Med 2013;19:36-41.
Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T, et al
. Asthma in adults and its association with chronic rhinosinusitis: The GA2LEN survey in Europe. Allergy 2012;67:91-8.
Kariyawasam HH, Rotiroti G. Allergic rhinitis, chronic rhinosinusitis and asthma: Unravelling a complex relationship. Curr Opin Otolaryngol Head Neck Surg 2013;21:79-86.
Celedón JC, Soto-Quiros ME, Hanson LA, Weiss ST. The relationship among markers of allergy, asthma, allergic rhinitis, and eczema in Costa Rica. Pediatr Allergy Immunol 2002;13:91-7.
Burrows B, Martinez FD, Cline MG, Lebowitz MD. The relationship between parental and children's serum IgE and asthma. Am J Respir Crit Care Med 1995;152:1497-500.
Freidhoff LR, Marsh DG. Relationship among asthma, serum IgE levels and skin test sensitivity to inhaled allergens. Int Arch Allergy Immunol 1993;100:355-61.
Freidhoff LR, Meyers DA, Marsh DG. A genetic-epidemiologic study of human immune responsiveness to allergens in an industrial population. II. The associations among skin sensitivity, total serum IgE, age, sex, and the reporting of allergies in a stratified random sample. J Allergy Clin Immunol 1984;73:490-9.
Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils, and eosinophils. J Allergy Clin Immunol 2010;125:S73-80.
Klink M, Cline MG, Halonen M, Burrows B. Problems in defining normal limits for serum IgE. J Allergy Clin Immunol 1990;85:440-4.
Sly M. Allergic disorders. In: Behrman RE, editor. Nelson Textbook of Pediatrics. 16th
ed.. Philadelphia: WB Saunders; 2000. p. 645-80.
Sharma RK, Mathur Y, Chhabra G, Luhadia A, Luhadia SK, Dhandoria G. A study of skin sensitivity to various allergens by skin prick test in patients of bronchial asthma and allergic rhinitis. Indian J Allergy Asthma Immunol 2018;32:47-53. [Full text]
Kumar R, Sharan N, Kumar M, Bisht I, Gaur SN. Pattern of skin sensitivity to various aeroallergens in patients of bronchial asthma and/or allergic rhinitis in India. Indian J Allergy Asthma Immunol 2012;26:66. [Full text]
Saleh BT. Evaluation of skin prick test for common aeroallergens in patients presented with bronchial asthma in Tikrit Teaching Hospital. Tikrit Med J 2012;18:57-63, 61.
Assarehzadegan MA, Shakurnia AH, Amini A. Sensitization to common aeroallergens among asthmatic patients in a tropical region affected by dust storm. J Med Sci 2013;13:592-7.
National Institute for Health and Care Excellence. Asthma: Diagnosis and Monitoring of Asthma in Adults, Children and Young People. Clinical Guideline – Methods, Evidence and Recommendations; January, 2015 (Draft for Consultation). London: National Institute for Health and Care Excellence; 2015.
Kerkhof M, Dubois AE, Postma DS, Schouten JP, de Monchy JG. Role and interpretation of total serum IgE measurements in the diagnosis of allergic airway disease in adults. Allergy 2003;58:905-11.
Mohammad S, Naila R, Khudhair, Nima S, Al-Fatlawi, Raheem H et al
. Relationship between Total Serum IgE Level and Skin Prick Test in Patients with Symptoms of Respiratory Allergy. Kufa J Nurs Sci 2016.
Gharagozlou M, Rastegari V, Movahedi M, Moin M, Bemanian MH. Total serum IgE and skin tests in children with respiratory allergy. Tanaffos 2005;4:27-31.
Parveen T, Begum N, Begum N. Allergen skin test reactivity and serum total IgE level in adult bronchial asthmatic patients. J Bangladesh Soc Physiol 2009;4:1-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]