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Test ID IGE Immunoglobulin E (IgE), Serum

Reporting Name

Immunoglobulin E (IgE), S

Useful For

Evaluation of patients with suspected diseases associated with elevations in total immunoglobulin E (IgE), including allergic disease, primary immunodeficiencies, infections, malignancies, or other inflammatory diseases

 

Diagnostic evaluation of patients with suspected allergic bronchopulmonary aspergillosis

 

Identification of candidates for omalizumab (anti-IgE) therapy

Specimen Type

Serum


Advisory Information


For a listing of allergens available for testing, see Allergens - Immunoglobulin E (IgE) Antibodies in Special Instructions



Specimen Required


Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Specimen Volume: 0.5 mL


Specimen Minimum Volume

For total IgE: 0.3 mL
For total IgE and more than 1 allergen: 0.05 mL x number of allergen-specific IgEs + 0.25 mL dead space

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
  Frozen  90 days

Reference Values

Results Reported in kU/L

Age

Reference interval

0-5 months

≤13

6-11 months

≤34

1 and 2 years

≤97

3 years

≤199

4-6 years

≤307

7 and 8 years

≤403

9-12 years

≤696

13-15 years

≤629

16 and 17 years

≤537

18 years and older

≤214

Day(s) and Time(s) Performed

Monday through Friday; 9 a.m.-8 p.m.

Saturday; 8 a.m.-3 p.m.

Test Classification

This test has been cleared, approved or is exempt by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

82785

LOINC Code Information

Test ID Test Order Name Order LOINC Value
IGE Immunoglobulin E (IgE), S 19113-0

 

Result ID Test Result Name Result LOINC Value
IGE Immunoglobulin E (IgE), S 19113-0

Clinical Information

Immunoglobulin E (IgE) is one of the 5 classes of immunoglobulins, and is defined by the presence of the epsilon heavy chain. It is the most recently described immunoglobulin, having first been identified in 1966. IgE exists as a monomer, and is present in circulation at very low concentrations, approximately 300-fold lower than that of IgG. The physiologic role of IgE is not well characterized, although it is thought to be involved in defense against parasites, specifically helminthes.

 

The function of IgE is also distinct from other immunoglobulins in that it induces activation of mast cells and basophils through the cell-surface receptor Fc epsilon RI. Fc epsilon RI is a high-affinity receptor specific for IgE present at a high density on tissue-resident mast cells and basophils. Because of this high-affinity interaction, almost all IgE produced by B cells is bound to mast cells or basophils, which explains the low concentration present in circulation. Cross-linking of the Fc epsilon RI-bound IgE leads to cellular activation, resulting in immediate release of preformed granular components (histamine and tryptase) and subsequent production of lipid mediators (prostaglandins and leukotrienes) and cytokines (interleukin-4 and interleukin-5).

 

Elevated concentrations of IgE are generally thought of in the context of allergic disease. However, increases in the amount of circulating IgE can also be found in various other diseases, including primary immunodeficiencies, infections, inflammatory diseases, and malignancies. Total IgE measurements have limited utility for diagnostic evaluation of patients with suspected allergic disease, except for allergic bronchopulmonary aspergillosis (ABPA). ABPA is a hypersensitivity reaction against the fungi Aspergillus that occurs most frequently in patients with asthma or cystic fibrosis. An elevation of total IgE is part of the diagnostic criteria for ABPA, although the specific diagnostic concentration is dependent on certain patient characteristics.

 

For patients with an established diagnosis of allergic disease, measurement of total IgE is necessary for identification of candidates for omalizumab (anti-IgE) therapy, and for determination of proper dosing. In addition to specific patient demographics and clinical presentations, candidates for omalizumab must have total IgE concentrations between 30 and 700 KU/L.

Interpretation

Elevated concentrations of total immunoglobulin E (IgE) may be found in a variety of clinical diseases, including allergic disease, certain primary immunodeficiencies, infections, inflammatory diseases, and malignancies.

 

Elevated total IgE concentrations may be consistent with a diagnosis of allergic bronchopulmonary aspergillosis, provided other laboratory and clinical criteria are fulfilled.

 

Total IgE concentrations between 30 to 700 KU/L may identify candidates for omalizumab therapy and may help to determine proper therapeutic dosing.

Clinical Reference

1. Homburger HA: Allergic diseases. In Clinical Diagnosis and Management by Laboratory Methods. 21st edition. New York, WB Saunders Company, 2007, pp 961-971

2. MartinsTB, Bandhauer ME, Bunker AM, et al: New childhood and adult reference intervals for total IgE. J Allergy Clin Immunol 2014; 133: 589-591

3. Bernstein IL, Li JT, Bernstein DI, et al: Allergy diagnostic testing: An updated practice parameter. Ann Allergy Asthma Immunol 2008 Mar;100(3 Suppl 3):S1-148

Analytic Time

Same day/1 day

Method Name

Fluorescence Enzyme Immunoassay (FEIA)

Forms

If not ordering electronically, complete, print, and send a General Request (T239) with the specimen.