Are Increased IgE‐Levels a Signal of an Acute Graft‐Versus‐Host Reaction?

Abstract

IgE-levels are markedly elevated following bone-marrow transplantation in patients with and without GVHD. In patients with GVHD, there is a significant correlation between the timing of the IgE-increase and the appearance of clinical GVHD (p less than 0.01). The highest IgE-level (8000 kU/l) was noted in a recipient of a syngeneic graft. During the IgE-peak, the serum from this patient contained low concentrations of IgE reacting with several tested allergens as well as for the hapten TNP, which indicated polyclonal activation. In a patient with a known allergy to animal danders, RAST tests were positive against dog and cat both before and six weeks after total body irradiation and transplantation with marrow from a non-allergic donor. A slight increase in the amount of allergen-specific, IgE-antibodies was seen during the increase in total IgE. A non-allergic patient was transplanted with marrow from a donor allergic to timothy. Timothy-specific, IgE-antibodies were detected immediately after transplantation but they disappeared within a few days and could not be detected during the period of increase in total IgE. We believe that the IgE-elevation seen after conditioning with cytotoxic drugs and total body irradiation in BMT-patients is a polyclonal response in host B-cells induced during an acute, GVHR and influenced by disturbed regulatory T-cells. Lymphocytes from patients with acute GVHD had unusually large numbers of IgG/PFC in vitro after stimulation with staph. aureus Cowan 1 (p less than 0.001), which may reflect a clonal expansion of responsive B-cells.

Transient Elevation of Serum IgE after Allogeneic Bone-Marrow Transplantation

“…IgE elevations after BMT have been attributed to the occurrence of clinically acute GvHD [3][4][5][6]23] and the suggestion was made that measurement of serum IgE could be useful for monitoring this syndrome [5]. Our results do not support these assumptions.…”

“…There is much indirect evidence in favor of a possible recipient origin of the IgE peaks described in this study. Ringden et al [6] described the simultaneous rise of total IgE and recipient allergen-specific IgE early after BMT, whereas in another patient, donor allergen-specific IgE could not be detected during the period of IgE elevation. Transfer of donor-type atopy to the recipient was reported to appear later than 3 months after BMT [59][60][61].…”

“…Ringden et al [4] observed a 2-to 750-fold increase in serum IgE in 20 of 25 patients following allogeneic or syngeneic BMT. The rise in serum IgE levels paral leled to some extent the occurrence of graft-versushost disease (GvHD) [5], although IgE peaks were also observed in patients without this condition [6]. Other investigators noted that (viral) infections after BMT were associated with similar changes in serum IgE [7], To evaluate whether IgE peaks are of value for monitoring acute GvHD or other events after BMT, we investigated serum IgE levels longitudinally in 52 children who underwent allogeneic BMT for leu kemia, severe aplastic anemia (SAA) and severe com bined immunodeficiency (SCID), and also in 8 chil dren treated with immunosuppression (IS) for SAA.…”

Autoantibodies of the IgM Class against a Human Myeloma Protein IgE(DES). I. Occurrence

“…It is interesting to note the appearance of rheumatoid factors in pa tients following kidney transplantation [23] which parallels the increase in IgM anti-IgE(DES) Ab con centration in one such patient observed by us. Whether this is directly or indirectly related to the de scribed increase of IgE in graft-versus-host reactions [24] is uncertain.…”

The Discovery of Immunoglobulin E and Its Role in Allergy

“…1 ml per day during a week, to a pholcodine-containing over-the-counter cough syrup in individuals who are IgE sensitized to pholcodine [38] . A similar increase is seen in graft-versus-host disease following bone marrow transplantation [39] .…”