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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 4  |  Page : 240-244

To evaluate total serum immunoglobulin E level and factors that effect on this level in Iraqi asthmatic children


1 Department of Medical Microbiology, University of Kerbala, Karbala, Iraq
2 Department of Pharmacology, University of Kerbala, Karbala, Iraq
3 Department of Consultant Pediatrician, Karbala Teaching Hospital for Children, Karbala, Iraq

Date of Submission25-Aug-2019
Date of Acceptance31-Oct-2019
Date of Web Publication03-Dec-2019

Correspondence Address:
Ms. Raghdah Maytham Hameed
Department of Medical Microbiology, University of Kerbala, Karbala
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_125_19

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  Abstract 


Background: Immunoglobulin E (IgE) has an important role in allergic disease, especially in asthma because it is highly responsive to the allergens; hence, the measure of IgE levels helps in the diagnosis of asthma and monitoring the patient state. Methods: The 85 asthmatic children, including 59 males and 26 females with asthma who had ages between 1 and 16 years collected at Karbala Teaching Hospital for Children with healthy controls which have same age and gender, were measured total IgE levels for them by using EUROIMMUN IgE ELISA kit. The clinical characteristics of patients were recorded by questionnaire and measurement of absolute eosinophil count by peripheral blood smear. Results: There was highly significantly different in IgE levels between patients and controls (P < 0.001). High IgE level observed in 42 (49.4%) of asthmatic patients was relating to age, eosinophil count, exposure to cigarette smoke, the severity of asthma, and use of treatment. Conclusions: Total serum IgE has an important role in the diagnosis of asthma and there are many factors affect its levels in asthmatic patients.

Keywords: Absolute eosinophil count, asthma severity, bronchial asthma, total serum immunoglobulin E


How to cite this article:
Hameed RM, Ahmed MM, Abood HA, Hussein AM. To evaluate total serum immunoglobulin E level and factors that effect on this level in Iraqi asthmatic children. Biomed Biotechnol Res J 2019;3:240-4

How to cite this URL:
Hameed RM, Ahmed MM, Abood HA, Hussein AM. To evaluate total serum immunoglobulin E level and factors that effect on this level in Iraqi asthmatic children. Biomed Biotechnol Res J [serial online] 2019 [cited 2019 Dec 8];3:240-4. Available from: http://www.bmbtrj.org/text.asp?2019/3/4/240/272186




  Introduction Top


Asthma is one of the most common chronic, noncommunicable diseases in children and adults.[1] It is a common condition due to chronic inflammation of the lower respiratory tract. It features variable airway obstruction and bronchial hyperresponsiveness.[2] Characterized by episodic or persistent symptoms of wheezing, dyspnea, and cough.[3] If an allergic trigger is suspected, an allergy diagnosis consisting of medical history and/or definition of the immunoglobulin E (IgE) should be performed.[4]

IgE is a type of antibody produced by plasma cells located in lymph nodes draining the site of antigen entry or locally, at the sites of allergic reactions, by plasma cells derived from germinal centers developing within the inflamed tissue.[5] IgE is pathogenic in allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergy.[6]

The pathogenic role of IgE antibodies in triggering and maintaining allergic inflammation in response to allergens is due to the binding of multivalent allergens to allergen-specific IgEs on sensitized effector cells. These interactions trigger effector cell activation, resulting in the release of potent inflammatory mediators, recruitment of inflammatory cells, antigen presentation, and production of allergen-specific antibody responses.[7] Hence, the presence of specific IgE antibodies can play an important role in identifying the relevant allergen and provide a guide to therapy.[8] Further, the elevated level of total serum IgE may demonstrate the allergic etiology of asthma in the subjects studied.[9]

In some studies, asthmatic children with higher asthma severity have a higher serum concentration of total IgE.[10],[11] While allergy symptoms may precede elevated specific IgE or represent a different pathway to asthma.[12] However, the role of IgE in allergic asthma is still a matter of debate.[13] Total IgE increased with age, but allergen-specific IgE levels significantly decreased with age, with a trend specific for each allergen tested.[14] Furthermore, IgE levels were higher in boys and differed across age groups in boys and girls.[15] Total IgE exhibits sexual dimorphism in humans (with males demonstrating higher IgE than females).[16] The elevated levels of IgE to some of the common environmental allergens suggests an important role of atopy in the expression of asthma in this developing country's urban setting.[17] Differences in total IgE levels and specific allergen sensitization are likely a result of the complex interplay between exposures associated with socioeconomic disadvantage.[18] It is influenced by exposure to passive smoking, pollen, cold, and pets and is associated with blood eosinophilia.[19],[20]

The presence of an IgE-mediated allergic reaction in patients with asthma is often related to a family history of the disease.[21] In conclusion, total serum IgE was found to be significantly associated with the age, exposure to cigarette smoke, and raised eosinophil count in asthmatic children.[9]

Ethical approval

The study protocol was approved by the ethical committee in the Karbala Health Directorate. In addition, verbal approval was taken from the patients and/or their parents before taking the sample. Health measures and safety were taken when sampling.


  Methods Top


Subjects

This study included a total of 85 consecutive asthmatic children (59 males and 26 females) attending the Asthma Clinic at Karbala Teaching Hospital for Children in the period extending from October 2018 to December 2018. All children had the American Thoracic Society criteria for asthma.[22] In this study, 36 of asthmatic children had visited the clinic regularly and receiving regular treatment with either inhaled corticosteroids (ICSs) or Montelukast, whereas 49 of them were newly diagnosed. Their ages were ranged between 1 and 16 years. The control groups included 85 children (53 males and 32 females) with the same ages and sex of the patients were randomly selected from the hospitals and the local community.

Sample collection and processing

Serum and whole blood were collected from each participant sera were used to determine total serum IgE levels by BioTek ELx 800 automated immunoassay analyzer (BioTek, USA) using EUROIMMUN total IgE ELISA kit (LOT NO. A180417AC). While whole blood was used for total and differential white blood cells (WBCs) count were measured using Sysmex XN-350 five differential automated hematology analyzer (Sysmex, Japan). Differential leukocyte count was displayed in percentage. Therefore, the absolute eosinophil count was measured by the following equation: Absolute Eosinophil Count = (WBC × Eosinophils %)/100

Data analysis

Data were introduced into a specific software Statistical Package for the Social Sciences version 21 for Windows (GraphPad Software, San Diego, California, USA) to do statistical analysis, while the figures constructed was by EXCEL program of Microsoft Office 2010 (GraphPad prism Microsoft).

The results were expressed as mean ± standard deviation comparisons between two mean were performed using t-test, whereas ANOVA was using to compare among mean. A value of P < 0.05 was considered to indicate the statistical significance and highly significant if P < 0.001. Chi-square used to compare between two categorical variables.


  Results Top


[Table 1] shows the demographic and biochemical profile of asthmatics and nonasthmatic children. Clinical characteristics of asthmatic participants between an elevated level of total serum IgE and normal IgE level are presented in [Table 2]. The results showed no significant associations of gender, age, height, weight, and body mass index between the asthmatic patients and healthy controls. While there was a highly significant difference of absolute eosinophil count, total serum IgE, and family history of asthma/allergic diseases between them P > 0.001, as shown in [Table 1].
Table 1: Demographic and biochemical profile of asthmatic and nonasthmatic groups

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Table 2: Comparison of demographic characteristics between asthmatic children with high-level immunoglobulin E and normal level of immunoglobulin E

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It was observed that 42 (49.4%) from 85 asthmatic patients have high total serum IgE. The mean of total serum IgE levels for + ve IgE (≥100 IU/mL) asthmatic children were 344.03 ± 215.9 IU/ml and for − ve IgE (<100 IU/mL) patients were 38.7 ± 28.2 IU/mL.

Furthermore, in this study, there was a significant difference in age, severity of asthma, exposure to cigarette smoke, absolute eosinophil count, and use of treatment between the elevated levels of total serum IgE in asthmatics patients compared to asthmatic patients who have normal levels of total serum IgE, shown in [Table 2]. On the other hand, there was no effect of the family history of asthma/allergic diseases on IgE levels as shown in [Figure 1] (P = 0.466). In [Figure 2], there was a significant difference in total serum IgE between mild and moderate asthmatic children (P = 0.049).
Figure 1: Difference between family history of allergic disease in mean of total serum immunoglobulin E

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Figure 2: The mean of total serum immunoglobulin E between mild and moderate asthmatic children. *: Significant (P < 0.05)

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  Discussion Top


The present study showed elevated total serum IgE (≥100 IU/ml) in 49.4% of asthmatic children. In addition, there was a highly significant difference between asthmatic and healthy controls in IgE level (P< 0.001). The result agrees with previous studies in Iraq, Haidar A. N. Abood, who mentioned that 48.7% of patients showed positive IgE screening test and 51.3% of patients showed negative IgE screening test.[23] Ahmad Al Obaidi et al. indicate that mean serum IgE level was 554 IU/ml in asthmatic patients, while that of the control was 69 IU/ml.[24] Further, the present results agree with previous international study, where Strømgaard et al. found a strong positive relationship between total serum IgE levels and asthma in children.[25] Increases in IgE levels could be viral (which is the most common cause of exacerbation of symptoms in asthma) or allergen-specific or could simply represent a generalized upregulation of IgE production.[26] Thus, IgE levels may be used to differentiate between asthmatic and nonasthmatic individuals.[24],[27]

The current study showed that the prevalence of atopy in asthmatic children is increased with age. In which the higher IgE level was present in 7.14% of patients aged <2 years, 21.4% of patients aged 2–5 years, and 54.76% of population at school age (5–10 years), this data similar to other previous studies[14],[28] which mentioned that when the age of asthmatic patients is considered, the IgE levels are greatly affected.

This study observed that male gender was predominant in both high IgE level and normal IgE level asthmatic children, and there was nonsignificant association between IgE level and gender, which agree with another study.[29] This result because childhood asthma was reported to be more prevalent in boys than in girls.[30]

Exposure to tobacco smoking was the most environmental factor cause the trigger of asthma and an increase of IgE levels.[20],[31],[32] This study found that 47% of patients who exposure to smoking had high IgE level, while only 32% of them had normal IgE level.

In spite of some evidence suggesting the relationship between living in urban and increase of IgE levels,[17] but the study showed asthmatic patients who lived urban was dominated at both high and normal IgE level, due to an increasing prevalence of asthma among children who lived in the urban area compared to children who lived in a rural area.[33]

In the present study, it was observed that high absolute eosinophils count (≥400 cell/mm3) for patients in high IgE group was 57% higher than that for patients in normal IgE group (39.5%), and there was a highly significant difference (P< 0.001). This result agrees with other previous study,[34],[35],[36] who mentioned that there was a positive relation of total IgE and total eosinophil count in allergic diseases.

Further, the data showed that 52.38% of asthmatic patients on controller therapy had high IgE level. This result is consistent with the previous results,[37] who said that the IgE level in the treated asthmatic patients was significantly higher than that in the asthmatic controls. Other previous study mentioned that only high doses of ICSs and montelukast decreased the serum IgE levels in asthmatic patients.[38] These result because of the montelukast action in asthmatic children which act by reduced interleukin (IL)-4 and IL-5 but increased of transferrin (TFN)-γ. Further, TFN-γ can inhibit the IL-4, induced high expression of IgE, and the occurrence of an allergic reaction.[37]

The present study showed 207.5 IU/ml of total serum IgE in moderate asthmatic children, while 164.3 IU/ml of total serum IgE in mild asthmatic children, this result agrees with another study such as Borish, who mentioned that 145.8 IU/ml mean of IgE levels in moderate asthmatic children while 137.8 IU/ml of total serum IgE in mild asthmatic children.[39] In addition, Kovac found 156.2 kIU/L of IgE levels in mild asthma and 288.0 kIU/L IgE in moderate asthma.[10] Sandeep who found that levels of IgE increased as the severity of asthma increased.[27] In contrast, Davila showed increase of total serum IgE in both mild and moderate asthma, whereas no differences between them.[40] The increase of IgE levels in mild and moderate asthma because IgE binds to high-affinity receptors on effector cells, such as basophils and mast cells. Then, allergen binds to IgE and initiates an inflammatory cascade, resulting in the release of proinflammatory mediators that contribute to the acute and chronic symptoms of asthma and allergic airway diseases.[41]

The study found that there was a highly associated between positive family history of asthma/allergic disease and asthma in children, 89.4% of asthmatic children had a family history of asthma, but there was no effect of this factor on the level of IgE, these results agree with Abood et al.[23]


  Conclusions Top


IgE plays an important role in the diagnosis of asthma and there are many factors effect on the IgE level in asthmatic children such as age, eosinophil count, exposure to cigarette smoke, and asthma severity.

Acknowledgment

We are thankful to the specialist doctors hematologist at Al-Sader hospital in AL-Najaf/Iraq (Dr. Thulfiqar Azeez Arab and Dr. Mohammed Abd Allah AL-Mosawi) for providing a helping in the examination of peripheral blood smear.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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