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Q:

7/22/2020
I am writing about a 15 year-old female who was found to have an IgE of 8,157. She is a new patient for me but presented with c/o "rashes" and itchy skin off and on for about four to five but not prior which is interesting. She is atopic and has spring time allergic rhinitis-+IgE to grass. She wheezed as a baby and a 7 year-old with URI, but does not have a history of recurrent infections, fever, cough, wheeze, diarrhea etc.- but +gastritis (had endoscopy). Other history is family visits South America yearly. Exam: c/w eczematous patches on face, and antecubitbal fossae and breast area with some papular lesions on abdomen. No urticaria edema etc.

My Question is based on my concern with such an elevated IgE level (she does not have eosinophilia). I believe she is atopic, does have atopic derm (eczema) and allergic rhinitis, but still feel that IgE needs to be worked up for non-allergic causes especially with her history of travel. I referred her for a CXR (r/o chest findings, lymphoma suggestion etc) and plan on sending her for blood work Helminth titers (ascaris, enterobius,shistosomiasis, strongyloides)
In light of her lack of eczema until the age of 15, do you agree with this assessment? What level of IgE is too high to "write off" as due to atopic dermatitis?

A:

I asked Dr. Donald Leung for his input. His response is as follows:

"In response to this query, there is no IgE so high that this adolescent could not have atopic dermatitis (AD). I have seen AD patients with IgE up to 150,000. The IgE of 8157 is frequently seen in AD but knowing the specific allergens is useful information and dust mites can induce levels of IgE in the thousands. Furthermore, staph aureus infection also induces very high IgE levels so the physician should culture the patient for S. aureus if there is any evidence for infection."

I hope this is helpful.

Regards,
Daniel J. Jackson, MD, FAAAAI

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