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Elevated IgE

Question:

9/21/2018
I have a 42 year-old WM with an IgE of 51,320. This was repeated 6 weeks apart. I called the medical director of the lab, because at first I thought it was a lab error, and he confirmed the results. He had an extensive erythematous scaly rash, which was diffuse. According to his parents, he was evaluated for the rash when he was very young, but since then has not seen an allergist or any kind of specialist except a dermatologist a couple of years ago. He has been fairly healthy with no h/o recurrent infections or hospitalizations. He does admit to having some seasonal allergy symptoms, although not severe. He also has some food allergies. I referred him to a dermatologist, who thought he may have either Darier’s disease or PRP (Pityriasis Rubra Pilaris), currently he is on methotrexate, and seemed to be responding.

His labs:
CBC 8.2, absolute Eos- 0.59, Mono 0.49, Lymph- 0.9
CMP- normal except for elevated glucose
IgG-1594, IgA- 120, IgM- 68
Tryptase- 7.2
ANA <1:80
Strongyloides ab, Toxocara ab- negative
CH 50 -111
LDH- 171
CRP- 1.4
Urine protein electrophoresis- normal
CD4- low normal 438 (500-2000)
CD 8 198 (200-1300)
CD4/CD8: 2.2
SPEP, UPEP- normal.

He doesn’t fit the criteria for Hyper IgE syndrome. I wonder if any of those rare skin diseases may be associated with high IgE. Please let me know what you think.

Answer:

I asked Dr. Donald Leung to provide advice. His response is as follows:

"It is not unusual for someone with severe eczema to have IgE>50,000. Is the patient sick? Has he had a long history of severe eczema? It is a good idea to get a skin biopsy to rule out cutaneous T cell malignancy.

  • do you have any serum IgE from earlier in life?
  • should rule out Staph aureus infection
  • patient is a good candidate for dupilumab if skin biopsy is normal

 
IgE Myeloma is extremely rare and if concerned the physician should refer to an oncologist."

I trust you will find this information helpful.

Best regards,
Daniel J. Jackson, MD, FAAAAI