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Total IgE is elevated in allergic conditions, parasitic infections, and atopic diseases.
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Total IgE Test Information Guide
- Why is it done?
- Measures the total level of immunoglobulin E (IgE) antibodies in the blood, which are produced by the immune system in response to allergens and certain infections
- Evaluates suspected allergic reactions including seasonal or environmental allergies, food allergies, and drug allergies
- Assesses symptoms such as itching, hives, angioedema, asthma, rhinitis, dermatitis, or gastrointestinal symptoms suggestive of allergic disease
- Screens for parasitic infections, particularly in patients with eosinophilia or unexplained symptoms in endemic regions
- Aids in diagnosing immunoglobulin E myeloma and other hematologic malignancies
- Typically performed during initial allergy evaluation, when acute allergic symptoms occur, or when monitoring response to allergen immunotherapy
- Normal Range
- Reference Range: Less than 150 IU/mL (or <120 ng/mL depending on laboratory); values may vary slightly based on age and laboratory methods
- Normal Result (Negative): IgE levels below 150 IU/mL typically indicate absence of significant allergic sensitization or parasitic infection; patient is not allergic to common allergens
- Mildly Elevated (150-300 IU/mL): Suggests possible allergic sensitization or mild allergic disease; warrants further investigation with specific IgE testing or clinical correlation
- Moderately Elevated (300-500 IU/mL): Indicates probable allergic disease or parasitic infection; recommend specific IgE testing to identify allergens
- Highly Elevated (>500 IU/mL): Strongly suggestive of allergic disease, parasitic infection, or possible hematologic malignancy (IgE myeloma); immediate follow-up testing recommended
- Unit of Measurement: IU/mL (International Units per milliliter) or ng/mL (nanograms per milliliter); 1 IU = 2.4 ng
- Interpretation
- Total IgE Elevation: Reflects overall immune response to allergens or parasites; higher levels correlate with increased allergic tendency but do not identify specific allergens responsible for symptoms
- Atopic Individuals: Tend to have chronically elevated IgE levels, often >200 IU/mL; presence of atopic syndrome predisposes to multiple allergic manifestations
- Parasitic Infections: May cause significant IgE elevation (often >1000 IU/mL); particularly important consideration in patients from endemic areas or with unexplained eosinophilia
- IgE Myeloma: Presents with extremely elevated IgE levels (often >5000 IU/mL); accompanied by monoclonal spike on protein electrophoresis and clinical signs of malignancy
- Clinical Correlation Essential: Normal or only mildly elevated IgE does not exclude allergic disease; conversely, elevated IgE without clinical symptoms may be clinically insignificant
- Factors Affecting Results: Age (children typically lower), ethnicity, geographic location, recent infections, medications (corticosteroids decrease IgE), active allergic disease state, and laboratory methodology variations
- Specific IgE Testing: Total IgE elevation should be followed by specific IgE testing to aeroallergens (pollen, dust mites, pet dander) or food allergens to identify causative agents
- Associated Organs
- Immune System: Primary system involved in IgE production; abnormal IgE production reflects dysregulated immune response with Th2 cell predominance
- Lungs and Airways: IgE-mediated allergic asthma, occupational asthma, exercise-induced bronchoconstriction; elevated IgE increases risk of asthma exacerbations
- Skin: Atopic dermatitis, urticaria, angioedema, and allergic contact dermatitis; IgE-mediated reactions cause mast cell degranulation leading to pruritus and inflammation
- Gastrointestinal Tract: Food allergies, eosinophilic esophagitis, eosinophilic gastroenteritis; IgE binding to allergens triggers mast cell activation in GI mucosa
- Upper Respiratory Tract: Allergic rhinitis, nasal polyposis, sinusitis; chronic IgE elevation perpetuates mucosal inflammation and eosinophil infiltration
- Bone Marrow: IgE myeloma and other plasma cell dyscrasias produce monoclonal IgE; malignant plasma cells infiltrate bone marrow causing anemia, thrombocytopenia, and lytic bone lesions
- Potential Complications: Anaphylaxis from severe IgE-mediated reactions, chronic airway remodeling from persistent allergic asthma, intestinal obstruction from eosinophilic enteritis, organ dysfunction from parasitic infections with high IgE
- Follow-up Tests
- Specific IgE Testing: Component-resolved diagnostics (CRD) or allergen-specific IgE panels targeting suspected allergens (e.g., tree pollen, shellfish, penicillin); identifies specific triggers for targeted avoidance and immunotherapy
- Complete Blood Count (CBC) with Differential: Evaluates eosinophilia which may suggest parasitic infection, allergic disease, or eosinophilic syndrome requiring further investigation
- Skin Prick Testing: Gold standard for aeroallergen allergy diagnosis; confirms clinical relevance of elevated IgE by demonstrating cutaneous hypersensitivity to specific allergens
- Serum Protein Electrophoresis and Immunofixation: Indicated when IgE >1000 IU/mL or other features suggest hematologic malignancy; identifies monoclonal immunoglobulin spike characteristic of myeloma
- Parasitic Serology and Stool Studies: Recommended for markedly elevated IgE especially in endemic regions; identifies specific parasitic infections (Ascaris, hookworm, schistosomiasis) requiring treatment
- Tryptase Level: Baseline serum tryptase should be measured if anaphylaxis suspected; helps identify mastocytosis in patients with recurrent anaphylaxis and elevated IgE
- Oral Food Challenge or Elimination Diet: Confirmatory testing for food allergies when specific IgE positive but clinical correlation unclear
- Pulmonary Function Tests (PFTs): Recommended for patients with elevated IgE and asthma symptoms; baseline spirometry helps assess airway obstruction and guide therapy
- Monitoring Frequency: Recheck total IgE annually in atopic patients on immunotherapy to assess response; more frequent monitoring needed during acute allergic exacerbations or when initiating new treatments
- Fasting Required?
- Fasting: No - Patient can eat and drink normally prior to blood draw; fasting does not affect total IgE measurement
- Medications: Continue all regular medications unless otherwise instructed; systemic corticosteroids can lower IgE levels, so timing relative to medication use should be noted
- Antihistamines: May be continued; do not affect IgE levels significantly and do not need to be discontinued prior to testing
- Patient Preparation: No special preparation required; can have blood draw at any time of day; sample can be collected in standard serum separator tubes
- Skin Testing Timing: If skin prick testing also planned, antihistamines should be discontinued 3-7 days prior to testing (depending on type) to avoid false negatives; however, this does not apply to total IgE blood test
- Optimal Timing: Avoid blood draw during acute anaphylaxis; IgE levels may transiently change during severe acute allergic reactions
How our test process works!
