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