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. Author manuscript; available in PMC: 2020 Jun 10.
Published in final edited form as: Int Forum Allergy Rhinol. 2018 Feb;8(2):108–352. doi: 10.1002/alr.22073

TABLE VIII.F.1-1.

Evidence supporting the use of total IgE in allergic rhinitis or allergy diagnosis

Study Year LOE Study design Study groups Endpoint Conclusiona
Park et al.902 2016 2b Prospective cohort 313 school children, 2-year follow-up study Initial examination: no allergic sensitization, serum tIgE >17.7 IU/mL Associated with the risk for allergic sensitization (sensitivity: 46.3%; specificity: 85.3%; OR: 4.8).
Initial examination: allergic symptoms but negative SPT, serum tIgE >17.4 IU/mL Associated with newly developed allergic sensitization (sensitivity: 69.9%; specificity: 100.0%).
Demirjian et al.896 2012 2b Prospective cohort Patients referred to allergy clinic. Total patients (n = 358,184 with rhinitis), mean age 57 years. Serum tIgE (IU/mL), continuous variable tIgE levels >140 IU/mL is suggestive of an atopic etiology for patients with rhinitis.
Jung et al.895 2011 2b Prospective cohort Patients with AR symptoms (n = 442), median age 33 years. Serum tIgE >98.7 IU/mL tIgE cutoff: 98.7 IU/mL is a strong predictor of AR. (OR 6.93; 95% CI, 4.19–9.62; p < 0.001); AUC: 0.79 [range, 0.74–0.83]; PPV: 71.3%; NPV: 73.7%.
Marinho et al.893 2007 2b Whole-population birth cohort 478 children from MAAS Serum tIgE (kU/L), continuous variable Borderline association with current rhinitis (UnAdjORb 1.2; 95% CI, 1.02–1.3), not significant at multivariate analysis. Association with current rhinoconjunctivitis (UnAdjORb 1.3; 95% CI, 1.1–1.5), not significant at multivariate analysis.
Li et al.901 2016 3b Retrospective case series Patients from otolaryngology clinic. Total patients (n = 610 adults, 349 with AR), median age 27.0 years. Serum tIgE (IU/mL), continuous variable Serum tIgE were higher in AR (166.0 [range, 58.4–422.5] IU/mL) than in NAR pts (68.8 [range, 24.5–141.0]) IU/mL. p < 0.001
Chung et al.899 2014 3b Retrospective case series Patients from otolaryngology clinic. Total patients (n = 1073 children and adults, 753 with rhinitis), mean age 36.9 years. Serum tIgE level >150 IU/mL Serum tIgE levels (cutoff value: 150 IU/mL) has good PPV (89.6%), and NPV (10%) in the in vitro diagnosis of AR (AUC: 0.88).
Jacobs et al.900 2014 3b Cross-sectional 547 children (6–14 years) from randomly selected households; 265 with skin test positive AR. Log serum tIgE (kU/L) Serum tIgE level are significantly associated with increased odds of skin test positive AR in children with asthma (OR 2.3; 95% CI, 1.5–3.5) but not with those without asthma (OR 1.6; 95% CI, 0.9–2.8). AR can be diagnosed if serum tIgE ≥100 kU/L both in asthmatics (AUC: 0.77 [range, 0.72–0.82], PPV: 85.1%, NPV: 68%) and in non-asthmatics (AUC: 0.84 [range, 0.79–0.89], PPV: 77.8%, NPV: 90.9%).
Hatcher et al.897 2013 3b Retrospective case series, followed by a prospective study
  1. 30 patients (≥6 years) with a negative allergy screen and serum tIgE >116 kU/L;

  2. 26 control patients with negative allergy screen and stIgE < 2.95 kU/L; Chronic sinusitis in 76.9% of study group and 19.2% of control group; p < 0.0001.

Serum tIgE (kU/mL), continuous variable Elevated serum tIgE in the presence of a negative inhalant-specific IgE screen may suggest the presence of unidentified inhalant allergen sensitization or chronic respiratory inflammatory disease other than AR. Mean serum tIgE of the study group was 363.3 kU/L vs control group 2.2 kU/L, p < 0.0001.
Karli et al.898 2013 3b Retrospective case series Patients from otolaryngology clinic with at least 2 complaints of nasal itching, nasal obstruction, rhinorrhea, and sneezing, and/or presumed AR (n = 295), mean age 33.9 years. Serum tIgE (U/mL), continuous variable tIgE <20 U/mL in 23.7%, tIgE 20-100 U/mL in 38.3%, tIgE >100 U/mL 33.8%. tIgE is a factor in confirming the diagnosis, but routine use is not recommended due to high cost and testing time.
Salo et al.454 2011 3b Cross-sectional 7398 subjects (>6 years) from NHANES 2005–2006. Serum tIgE (kU/L), continuous variable Association with current HF (OR 1.9; 95% CI, 1.4–2.4).
Children (6–17 years) Serum tIgE >40.8 kU/L (median) Association with current HF (OR 2.1; 95% CI, 1.4–3.1).
Serum tIgE (kU/L), continuous variable Association with current HF (OR 2.2; 95% CI, 1.1–4.4).
Adults (>18 years) Serum tIgE (kU/L), continuous variable Association with current HF (OR 1.9; 95% CI, 1.4–2.6).
Male Serum tIgE (kU/L), continuous variable Association with current HF (OR 2.1; 95% CI, 1.6–2.8).
Female Serum tIgE (kU/L), continuous variable Association with current HF (OR 1.7; 95% CI, 1.2–2.3).
Kalpaklioglu et al.894 2009 3b Retrospective case series Consecutive and unselected pts from a tertiary care clinic (n = 323,205 with AR); mean age 31.7 years Serum tIgE (IU/mL), continuous variable Serum tIgE higher in AR (261) than in NAR (126), p < 0.01.
Ando & Shima892 2007 3b Cross-sectional School children (n = 98 with AR), 9–10 years old Serum tIgE levels (IU/mL) expressed as geometric means, continuous variable Serum tIgE higher in AR (230.4; 95% CI, 157.6–337.0) than in NAR (96.5; 95% CI, 76.9–121.1), p < 0.001
a

All reported ORs are adjusted unless differently specified and are reported with 95% CIs in parentheses.

b

The OR indicates an increase in the risk of current rhinitis/chronic RC per log unit increase of IgE levels.

AR = allergic rhinitis; AUC = area under the curve; CI = confidence interval; HF = hay fever; IgE = Immunoglobulin E; LOE = level of evidence; MAAS = Manchester Asthma and Allergy Study; NAR = non-allergic rhinitis; NHANES = The National Health and Nutrition Examination Survey; NPV = negative predictive value; OR = odds ratio; PPV = positive predictive value; RC = rhinoconjunctivitis; SPT = skin prick test; tIgE = total immunoglobulin E; UnAdjOR = unadjusted odds ratio.

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