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Table 3 Medical conditions associated with elevated or very low/absent IgE levels

From: AllergoOncology: ultra-low IgE, a potential novel biomarker in cancer—a Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI)

  Type I hypersensitivity Parasitosis Cancer Other conditions associated with elevated IgE levels
Elevated total and specific IgE levels Asthma and allergic rhinitis
In asthma, omalizumab treatment is dosed based on total IgE [56]
Total IgE level is useful in diagnosis and monitoring of ABPA flares [44]
ssIgE levels depict environmental sensitizations and could guide specific immunotherapy [57]
Food allergy
ssIgE levels to certain foods/molecules predict risk of anaphylaxis [60]
Venom allergy
ssIgE used in venom allergy diagnosis [63]
Drug allergy
ssIgE to penicillin may be useful to diagnose recent anaphylaxis [65]
ssIgE to alpha-gal associated with cetuximab anaphylaxis [66]
IgE levels decrease significantly after effective anti-parasitic therapy [73]
IgE myeloma [147]
Hypereosinophilic syndromes [148]
Lymphoma [146, 149, 150]
Atopic dermatitis
May be associated with extremely high IgE levels [29]
Immunodeficiency [83]
HyperIgE syndrome, Wiskott Aldrich syndrome, Immunodysregulation polyendocrinopathy enteropathy X-linked syndrome (IPEX), Omenn syndrome, Atypical complete DiGeorge syndrome
Chronic spontaneous urticaria
Anti-IgE therapies support the role of IgE in pathophysiology [101, 151]
IgE-mediated autoimmunity
(systemic lupus [152], bullous pemphigoid [153], pemphigus vulgaris [154], autoimmune uveitis [155], rheumatoid arthritis [156], multiple sclerosis [157], autoimmune pancreatitis [158])
IgG4-related disease [87]
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) [88], Wegener’s granulomatosis [159], sarcoidosis [160]
Viral infections [89, 161]
  Type I hypersensitivity Parasitosis Cancer Other conditions associated with low IgE levels
Very low (< 2.5 kU/mL) or absent total IgE levels The full clinical significance of very low IgE levels is unknown
May cause false negative skin tests and ssIgE results despite clinical suspicion of atopy/allergy
The rates of asthma and allergic rhinitis diagnoses are lower compared with non-IgE deficient patients, however, allergy-type symptoms are not absent
[32, 37, 58]
It is unknown if humans with IgE deficiency would have higher rates or risk of developing parasitic infections Higher rates and risk of malignancy compared with non-IgE deficient patients [32,33,34, 37] Common Variable Immunodeficiency (CVID) [38]
Selective IgE deficiency [162]
Hyper-IgM syndrome [163]
  1. ssIgE serum specific IgE