|Year : 2020 | Volume
| Issue : 2 | Page : 81-86
Relationship between total serum immunoglobulin E level and total eosinophils count with skin reactivity in children with allergic rhinitis and asthma in North Indian population
Radhey Shyam Sharma, Ravi Sharma, Rajiv KR Bansal
Department of Pediatrics, Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India
|Date of Submission||14-Apr-2020|
|Date of Acceptance||19-Aug-2020|
|Date of Web Publication||20-Nov-2020|
Dr. Radhey Shyam Sharma
D-74B, Siwad Area, Bapu Nagar, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
CONTEXT: Various epidemiological studies have shown association among total serum immunoglobulin E (IgE) levels, blood eosinophilia, skin test reactivity, and allergy prevalence, the details of these associations has still not well determined specially in the Indian population.
AIMS: The aim of this study is to determine the correlation between total serum IgE level, total eosinophils counts (TECs), and skin prick test (SPT) for common aeroallergens in children with allergic rhinitis (AR) and asthma.
SETTINGS AND DESIGN: A prospective, cross sectional, and observational study conducted at Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India, between October 2018 and June 2019.
MATERIALS AND METHODS: A total of 140 children of age 6–18 years diagnosed with AR and Asthma were enrolled. SPT using 18 aeroallergens were performed with the measurement of total serum IgE level and TEC.
RESULTS: Among the total cases, around 77% (n = 108) were having positive skin test for one or more allergens, most common allergen was house dust mite. Total serum IgE level was strongly related with skin reactivity in both AR and asthma groups (correlation coefficient = 0.68), and a fair correlation was also observed between TEC and SPT grade in our all study participants (r = 0.48).
CONCLUSION: Our study suggested a close relationship between total serum IgE and TEC and skin test reactivity in children with AR and asthma.
Keywords: Aeroallergen, allergic rhinitis, asthma, house dust mite, Rajasthan
|How to cite this article:|
Sharma RS, Sharma R, Bansal RK. Relationship between total serum immunoglobulin E level and total eosinophils count with skin reactivity in children with allergic rhinitis and asthma in North Indian population. Indian J Allergy Asthma Immunol 2020;34:81-6
|How to cite this URL:|
Sharma RS, Sharma R, Bansal RK. Relationship between total serum immunoglobulin E level and total eosinophils count with skin reactivity in children with allergic rhinitis and asthma in North Indian population. Indian J Allergy Asthma Immunol [serial online] 2020 [cited 2021 Mar 1];34:81-6. Available from: https://www.ijaai.in/text.asp?2020/34/2/81/300916
| Introduction|| |
Allergic diseases affects lives of more than one billion people worldwide; asthma and allergic rhinitis (AR) are common among them. Fourteen percent children experience asthma symptoms according to global asthma report. Allergy once considered diseases of rich and of western world, is now increasingly affecting middle income group and poor people in the developing countries. The prevalence of asthma in India estimated to range from 3% to 38%.,
AR considered as the most common allergic disease afflicting 10%–30% population globally and more than 50% of atopies in India.
The response of the immune system of the sensitized person to the allergen as a result of a series of reactions, mediated by many immune mediators, including eosinophils, mast cells, and basophils which can be defined in vitro using various parameters such as total immunoglobulin E (IgE), specific IgE, and eosinophil counts.
It is established that IgE plays a pivotal role in the pathogenesis of allergic diseases. Total serum IgE level and total eosinophil counts (TECs) are widely used as a diagnostic tool for allergic diseases. In routine clinical practice, a combination of total serum IgE and TEC is used to rule out allergic diseases.
Among various allergens, house dust mite (HDM), cockroach, mosquito, fungus (Alternaria), dog, and cat dander are common indoor allergens implicated in various allergic disorders,,, while according to aerobiology of North India, Parthenium, Holoptelia, Chenopodium sps., Cynadon sps., Amaranthus sps., Ricinus comunis, Brassica sps. and Zea mays are some common outdoor allergens.
Studies have shown strong association among total serum IgE levels, blood eosinophilia, skin test reactivity, and allergy prevalence, the details of these association is still not well determined.
This study is being conducted in Jaipur, Rajasthan, North India, to compare and correlate total serum IgE levels and TECs to common 18 aeroallergens by skin prick test (SPT), which is considered as gold standard test for the diagnosis of clinical allergy. We have chosen here 18 most common aeroallergens because of wide prevalence of reactivity to these allergens in allergic patients which is well established by regional aerobiology and various studies.,,,
| Materials and Methods|| |
This was a prospective, observational study conducted at Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India. One hundred and forty children with allergic disease (Astham and AR) were enrolled between October 2018 and June 2019.
In all cases, sociodemographic data, including age, sex, date of birth, socioeconomic status, etc., and detailed history regarding, presenting symptoms, duration of symptoms, seasonality of symptoms, environmental and precipitating factors history, history of treatment prior to hospitalization, etc., were obtained.
All patients were categorized into urban and rural class according to definition by census of India 2011.
All participants were divided into two disease groups: Predominant Asthma and predominant AR, after detailed medical history and physical examination.
Diagnosis of Asthma was established by Global Initiative for Asthma (GINA) guideline 2018. Characteristics symptoms pattern on history and evidence of variable airflow limitations (spirometry/reversibility test).
Diagnosis of AR by Allergic Rhinitis and its Impact on Asthma (ARIA) guideline 2007: Based on symptomatology-rhinorrhea, nasal blockage, nasal itching and sneezing, which are reversible spontaneously or with treatment.
Skin prick test
After detailed history and examination clinical diagnosis of AR and asthma being made (ARIA and GINA guidelines). SPT has been performed for 18 aeroallergen: Holoptelia, Amaranthus spinosus, Argemone maxicana, Brassica sps., Chenopodium album, Ricinus comunis, Male and female cockroach, Mosquito, HDMs (D. Farinae, D. Ptronyssinus), Parthenium sps., Zea mays, Alternaria, Cat dander, Dog dander, Cynadon dactilon and Grain dust, using standard allergen extracts prepared by Alcure pharma, Delhi. Skin pricks were done using standard protocol with a sterile lancet under all aseptic precautions. Histamine is used as positive control and Normal saline as negative control. Test results were read after 15–20 min. An emergency kit (containing inj. Adrenaline, Hydrocortisone, Chlorpheniramine) was always there at testing site for management of any adverse reaction. Test was considered positive if wheal in any of the allergens was 3 mm or more than the positive control.
Total serum immunoglobulin E and total eosinophils count analysis
Venous blood sample has been taken from each patient and total serum IgE level and TEC was measured.
Categorical data has been presented as numbers (percent) and were analyzed using using Chi-square test/Fischer exact test as applicable.
Correlation between quantitative variables has been assessed by using Pearson's/spearman correlation coefficient as applicable. For inference of correlation coefficient:
- r ≥ 0.8 = Very strong correlation
- 0.6–0.8 = Moderately strong correlation
- 0.3–0.5 = Good correlation
- <0.3 = Poor/weak correlation.
A Probability P = 0.05 was considered as statistically significant.
All statistical analyses were done using Medcaclc 16.4 statistical software (Medcalc Software, Ostend, Belgium).
| Results|| |
This study was done in Pediatric outpatient department (OPD), at SDM Hospital, Jaipur. Total 140 children (70 Asthma and 70 AR) were enrolled for the study. The following observations were made:
[Table 1] shows basic demographic and geographic data of study subjects. Children enrolled were mostly of age group 6–15 years (93.6%, n = 131). There is statistically significant difference (P = 0.008) seen in the prevalence of asthma and AR i.e., the asthma is more prevalent in younger children (80%, n = 56) as compared to AR (58.6%, n = 41). 78.6% (n = 110) were male and 21.4% (n = 30) female participated in the study. 55.7% (n = 78) cases were from rural background and 44.3% (n = 62) from urban.
[Table 2] depicts the skin test reactivity in AR and asthma groups. 77.1% (108) cases of both AR and asthma showed positive skin test to at least 1 aeroallergen or more. Both groups showed equal skin reactivity in our study, no significant difference seen in both study group.
[Table 3] illustrates the prevalence of different aeroallergens in AR and asthma patients. Common allergens in our study were HDM (n = 49, 45.3%), Cockroach (n = 45, 41.7%), mosquito (n = 45, 41.7%), grain dust (n = 31, 28.7%) and haloptelia (n = 28, 25.9%). HDM was the commonest offending allergen in Asthma patients (41.4%, n = 29) and mosquito (32.9%, n = 23%) in AR patients.
|Table 3: Distribution of study subjects according to prevalence of allergens sensitivity|
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[Table 4] represents the relation of mean IgE level with SPT positivity. In our study with 140 total subjects, mean IgE level was significantly high (759.5 ± 607.7) in SPT positive cases (n = 108) in comparison to SPT negative (n = 32) cases (235.4 ± 271.7) (P < 0.001).
|Table 4: Mean immunoglobulin E level of study subjects in relation to skin prick test positivity|
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[Table 5] shows the relationship of TEC to SPT positivity in study subjects. According to our study analysis, mean of TEC in SPT positive (n = 108) was 645.6 ± 487.7 and in SPT negative (n = 32) was 370.3 ± 354.5, which is also significant statistically (P = 0.004).
|Table 5: Mean total eosinophils count level of study subjects in relation to skin prick test positivity|
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Regarding correlation between IgE level and skin prick reactivity grading, we observed in this study that total serum IgE level is strongly related with skin reactivity in both AR and asthma groups (correlation coefficient = 0.68) as depicted in [Graph 1] and [Graph 2].
According to pearsons correlation coefficient, not as strong but a good correlation was observed between TEC and SPT grade in our all study subjects (r = 0.48) as illustrated by [Graph 3] and [Graph 4].
| Discussion|| |
This study was carried out to determine correlation between total serum IgE level and TEC with SPT for 18 common aeroallergens in children with AR and asthma. A total 140 pediatric patients (70 AR and 70 asthma), who presented at pediatric OPD at a tertiary care centre in Rajasthan, India, with respiratory allergy were enrolled for the study.
In present study, total 140 patients of aged 6–18 years were enrolled. Most of the cases were below 10 years of age. In this study, there is a significant difference observed between age distribution of AR and asthma groups as the Asthma is more prevalent in younger age group in comparison to AR. Eighty percent of Asthma cases were of age group 6–10 years similar age distribution for asthma was observed in study by Jain et al. and Bayram et al. who found the prevalence of Asthma more in younger age group. Male: female ratio of study subjects was around 4:1 for this study, 78.9% participates were male. 57.1% of cases of AR and 54.3% of cases diagnosed as asthma were from rural background. In a study by Lama et al. their 80% of subjects with asthma were from rural background.
In this study of total 140 subjects, we performed skin prick testing using 18 aeroallergens and was positive of various grades with 1 or more allergens in 77.1% of cases (n = 108). Both the study groups, AR and Asthma showed equal incidence of SPT positivity (77.1% each), no significant difference was seen in both groups. Study by Ibekwe and Ibekwe  in 96 allergic patients of Niegeria, showed similar results with SPT i.e., 77% SPT positivity (n = 74). Various studies from India and abroad showed high prevalence of SPT positivity. Studies like Siroux et al. found 88.2% (n = 122) SPT positivity, Raj et al. 55.6% (n = 100), Prasad et al. 89.5% (n = 43) and Kumar et al. showed 71.3% (n = 3040) SPT positive in their respective studies.
In our study, we found that the commonest offending allergen in asthma patients was HDM (41.4%, n = 29) and Cockroach (32.9%, n = 23) in AR patients, followed by mosquito (32.1%, n = 45), grain dust (22.1%, n = 31) and haloptelia (20%, n = 28).
Many Indian study showed the similar pattern of allergen sensitization with common allergens. Study by Prasad et al. found the common offending allergens were insects (21.8%, n = 10). In Shyna et al. study from South India, HDM was the commonest offending allergen (33%, n = 20) similar to our study. Raj et al. found some different pattern of prevalence of sensitization in North India. In their study, Housefly was the commonest allergen, not HDM.
In our study with 140 total subjects, mean IgE level was significantly high (759.5 ku/L) in SPT positive cases in comparison to SPT negative cases (235.4ku/L) (P < 0.001), and total IgE level is strongly related to SPT grading in both AR and Asthma patients (correlation coefficient: 0.70 and 0.67 respectively). Kim et al. also found similar relation between SPT positivity and mean IgE in Korean children of 2 age group-6–7 years and 12–13 years. Total IgE levels were higher in children who had a positive SPT response than in those who did not (all P < 0.001 at both age groups). Brown et al. found the similar relation between total IgE and SPT. Correlation coefficients between prick responses to individual allergens and total IgE levels were significant from P < 0.01 to < 0.001, Increasing IgE levels are positively correlated with increasing skin reactivity by prick test. But Gharagozlou et al. interestingly found in their study that in the patients with asthma and AR, there was no correlation found between total IgE levels and SPT results (r = 0.228, P = 0.005 and r = 0.235, P = 0.037).
TEC were high in SPT positive cases (n = 108), in comparison to SPT negative cases (n = 32). Mean TEC in SPT positive group was 645.6 ± 487.7 (Standard deviation [SD]) while in SPT negative group it was 370.3 ± 354.5(SD) which is significant statistically (P = 0.004). There is a good correlation between TECs and SPT grade (r = 0.48). Similarly Siroux et al. and Deo et al. also found the positive relation between SPT and blood eosinophilia.
Thus, our results seem to confirm the significant relationship between total IgE and TEC with SPT. Regarding the recent studies, SPT itself is one of the most effective measurements of atopy and correlates well with other in vitro blood tests like IgE level and eosinophils count (with total IgE level > TEC).
| Conclusion|| |
The present study suggests that there is a close relationship between nonspecific allergic markers, namely total serum IgE and TEC and skin test reactivity in children with AR and Asthma. All three parameters can be a predictor of one another in the evaluation of children with allergic conditions. Total serum IgE levels and TECs reflect the severity of the inflammatory processes in allergic disorders, while SPT shows the sensitization of an individual with the specific allergen.
It is recommended that total serum IgE levels and peripheral eosinophil counts should be done in all cases of AR and asthma along with other specific investigations such as skin prick testing, for arriving at a proper diagnosis and management.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Akdis CA, Hellings P, Agache I. Global Atlas of Allergy. Switzerland: European Academy of Allergy and Clinical Immunology; 2014. p. XIII.
The Global Asthma Report 2014. Auckland, New Zealand: Global Asthma Network; 2014.
Kant S. Socio-economic dynamics of asthma. Indian J Med Res 2013;138:446-8.
] [Full text]
International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variations in the prevalence of asthma symptoms: The International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998;12:315-35.
Chowdary VS, Vinaykumar EC, Rao JJ, Rao R, Ram Babu K, Rangamani V. A study on serum IgE and eosinophils in respiratory allergy patients. Indian J Allergy Asthma Immunol 2003;17:21-4.
Karli R, Balbaloglu E, Uzun L, Cinar F, Ugur MB. Correlation of symptoms with total IgE and specific IgE levels in patients presenting with allergic rhinitis. Ther Adv Respir Dis 2013;7:75-9.
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.
Saha GK. House dust mite allergy in Calcutta, India: Evaluation by RAST. Ann Allergy 1993;70:305-9.
Droste JH, Kerhof M, de Monchy JG, Schouten JP, Rijcken B. Association of skin test reactivity, specific IgE, total IgE, and eosinophils with nasal symptoms in a community-based population study. The Dutch ECRHS Group. J Allergy Clin Immunol 1996;97:922-32.
Shyna KP, Veena Kumari M, Divya Krishnan K, Abdul Azeez VK. Clinical profile and skin prick test analysis in children with allergic rhinitis of North Kerala, India. Int J contemp pediatr. 2018;5:372-6.
Dey S, Chakraborty T. Prevalence study of common environmental allergens in children with asthma and allergic rhinitis in Kolkata: A hospital based study. Indian J Child Health 2016;3:225.
Bhattacharya K, Sircar G, Dasgupta A, Gupta Bhattacharya S. Spectrum of allergens and allergen biology in India. Int Arch Allergy Immunol 2018;177:219-37.
Adkinson NF Jr. Clinical significance of immunoglobulin E. In: Middleton's Allergy, Principal and Practice. 6th
ed. Philadelphia: Mosby; 2003. p. 1087-103.
Ibekwe PU, Ibekwe TS. Skin prick test analysis in allergic rhinitis patients: a preliminary study in Abuja, Nigeria. J Allergy. 2016;2016.
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention; 2018.
Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al
. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol 2017;140:950-8.
Jain A, Vinod Bhat H, Acharya D. Prevalence of bronchial asthma in rural Indian children: A cross sectional study from South India. Indian J Pediatr 2010;77:31-5.
Bayram I, Güneşer-Kendirli S, Yilmaz M, Altintaş DU, Alparslan N, Bingöl-Karakoç G. The prevalence of asthma and allergic diseases in children of school age in Adana in southern Turkey. Turk J Pediatr 2004;46:221-5.
Lama M, Chatterjee M, Chaudhuri TK. Total serum immunoglobulin e in children with asthma. Indian J Clin Biochem 2013;28:197-200.
Siroux V, Oryszczyn MP, Paty E, Kauffmann F, Pison C, Vervloet D, et al
. Relationships of allergic sensitization, total immunoglobulin E and blood eosinophils to asthma severity in children of the EGEA Study. Clin Exp Allergy 2003;33:746-51.
Raj D, Lodha R, Pandey A, Mukherjee A, Agrawal A, Kabra SK, et al
. Aeroallergen sensitization in childhood asthmatics in Northern India. Indian Pediatr 2013;50:1113-8.
Prasad R, Verma SK, Dua R, Kant S, Kushwaha RA, Agarwal SP. A study of skin sensitivity to various allergens by skin prick test in patients of nasobronchial allergy. Lung India 2009;26:70-3.
] [Full text]
Kumar R, Kumar M, Bisht I, Singh K. Prevalence of aeroallergens in patients of bronchial asthma and/or allergic rhinitis in India based on skin prick test reactivity. Indian J Allergy Asthma Immunol 2017;31:45-55. [Full text]
Kim HY, Choi J, Ahn K, Hahm MI, Lee SY, Kim WK, et al
. Reference values and utility of serum total immunoglobulin E for predicting atopy and allergic diseases in Korean schoolchildren. J Korean Med Sci 2017;32:803-9.
Brown WG, Halonen MJ, Kaltenborn WT, Barbee RA. The relationship of respiratory allergy, skin test reactivity, and serum IgE in a community population sample. J Allergy Clin Immunol 1979;63:328-35.
Gharagozlou M, Rategari V, Movahedi M, Moin M, Hassan BM. Total serum IgE and skin tests in children with respiratory allergy. Tanaffos 2005;15:27-31.
Deo SS, Mistry KJ, Kakade AM, Nniphadkar PV. Relationship of total IgE, Specific IgE, skin test reactivity and eosinophils in Indian patients with allergy. JIACM 2010;11:265-71.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]