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AND THE ANSWER IS . . .
Although one generally thinks of typical allergic reactions when the
term IgE is mentioned, a serum IgE level of 1500 IU/mL described above
is generally much higher than seen in allergic rhinitis and most cases
of allergic asthma (1). However, serum IgE levels 1500 IU/dl or even
higher are not unusual in atopic dermatitis when the skin eruption is
generalized and particularly when there is extensive secondary infection
(2). In contrast, serum IgE levels are normal or only slightly elevated
in chronic idiopathic urticaria . This situation may reflect the fact
that IgE-mediated reactions are only occasionally found to be the cause
of apparently idiopathic chronic urticaria in adults (3). A condition
that does sometimes occur in chronic asthmatics that may result in a
markedly elevated serum IgE level is allergic bronchopulmonary
aspergillosis (ABPAP (4). Indeed when I hear about an asthmatic with a
very high IgE level, one of the first things that I think of is the
possibility of ABPA. Another condition in which there may be at least
transient wheezing (and sometimes angioedema) along with considerably
elevated serum IgE and eosinophilia is trichinosis, which has a
transpulmonary migration pathway it its life cycle in humans (5).
However, in parasitic infections confined to the G-I tract such as
pinworm, the serum IgE level is usually is usually normal or only
slightly elevated. Considerably elevated serum IgE levels are almost
always present in the Job-Buckley syndrome, hence its other name, the
"Hyper-IgE syndrome".(6) Many of such patients typically have
chronic/recurrent Staph infection of the skin and sometimes internal
organs. In such cases, a good bit of the elevated IgE levels are
composed of IgE anti-staph antibodies.
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