Neonatal IgE: a poor screen for atopic disease

Abstract

Screening for atopic disease using neonatal serum IgE has been advocated on the basis of the predictive value of elevated levels. However, this is only one measure of validity. The test was validated fully in 92 infants with a bi-parental history of atopy using 0.7 IU/ml as the cut-off. All infants were assessed prospectively for evidence of atopic disease (eczema, recurrent wheezing or food reactions) and skin-prick test positivity in the first year. Total serum IgE was measured by ultrasensitive ELISA on 61 cord blood samples and 92 samples taken at 7 days. All cord samples were re-analysed by PRIST and the first 33 by ultrasensitive RIA giving, respectively, 82% and 94% concordance (regarding undetectable, detectable and elevated levels) with ELISA. Maternal contamination was indicated in 7% of cord samples by high serum IgA. Ninety-five per cent of cord/7-day IgE pairs showed no change or minor rises at 7 days. Forty-nine per cent of the infants had evidence of atopic disease. Only 5% had elevated 7-day IgE. The positive and negative predictive values of the 7-day test were 60% and 52%, respectively, and specificity 96% but the sensitivity was only 7%. High levels did not distinguish the infants with the most unequivocal evidence of disease, i.e. eczema with a positive skin test. In conclusion IgE at 7 days is comparable to and more reliable than cord IgE. However, neonatal IgE screening is too insensitive to have clinical application.

Maternal Antigen Stimulation Downregulates via Mother’s Milk the Specific Immune Responses in Young Mice

“…Atopic mothers, in contrast, were reported to modify the development of the infant’s immune response towards the allergic phenotype [10, 11]. However, this was attributed mainly to transplacental exposure to maternal antibodies and cytokines.…”

“…Transmission of atopy at the chromosome locus 11q was shown to be detectable only through the maternal line [10, 11]. These studies suggest that an atopic mother can modify the development of the infant’s immune response towards the allergic phenotype, possibly by factors experienced by the fetus in utero.…”

“…Ruiz et al [10]reported that significantly more children of allergic mothers developed allergic eczema than those of allergic fathers. Transmission of atopy at the chromosome locus 11q was shown to be detectable only through the maternal line [10, 11].…”

Prevalence of Allergy Symptoms and Total IgE in a New York City Cohort and Their Association with Birth Order

“…This finding may suggest that our children experience increased susceptibility to intrauterine factors (e.g., T helper 2, IL-4 or IL-13, cytokine production, allergen exposure, maternal lifestyles) suspected of increasing isotype class switching to IgE in utero[21]. But in general, the independent predictive value of cord blood IgE for risk of allergy or asthma remains unconvincing in most [22,23,24], but not all [25, 26], studies. Our results in the inner-city population do not support an association between increased cord blood IgE and increased risk of early respiratory disease including asthma, possibly diminishing its clinical importance.…”

Genetic and Perinatal Risk Factors for Asthma Onset and Severity: A Review and Theoretical Analysis

“…The human fetus appears to produce IgE, but at relatively low levels. Nonetheless, higher total IgE levels in cord blood (>0.8 kU/ liter) have been observed and were associated with increased risk for atopic disease in infancy, including atopic dermatitis (98,99), and urticaria from food allergy (100), but the majority of studies have found little predictive value of cord blood IgE on asthma or asthmatic symptoms (98)(99)(100)(101)(102)(103)(104)(105)(106)(107) because of the low sensitivity and predictive value of IgE (98,102,(107)(108)(109). However, none of the studies of the predictive value of cord blood IgE has been conducted among subjects with any substantial understanding of their genetic polymorphisms, examples of which have just been described, or a detailed examination of their residential aeroallergen exposure, reviewed below.…”