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Selective IgE Deficiency

As most of us know severe asthma can be caused by hyper immune response with elevated Eosinophils and elevated IgE.  This is what my doctor expected with me, but labs told a different story.  0 eosinophils and 0 basophils.  All immunoglobulins in normal range, except IgE which was less than 2 indicating a deficiency.  This would make since considering i'm anaphylactic to shellfish, yet with blood serum testing I showed no sign of allergy to them as they look for elevated IgE levels as a response.  I also have a hard time accepting immunizations, such as having the hep b series multiple times with titters showing now evidence of immunity.  Currently I am having a hard time finding any information or research about this particular deficiency.  Anyone here have any experience with this or advice?  I don't meet with my doctor for another month but was advised to get a pneumonia vaccine asap and just trying to educate myself on this so I can narrow down some of the questions I have when we do meet.

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  • K8sMom2002

    Wow, Brian, very interesting … I have heard of people with immune issues and asthma. I'm glad you're following up with your doctor.

    In the meantime … Your question sounds like a good question to submit to AAFA's free Ask the Allergist™ service.  You can fill out this , and a board-certified allergist will reply within a couple of weeks. 

  • Shea

    Hi Brian– welcome to the forum. I have had negative blood tests but positive skin patch tests to foods and environmentals that I am allergic to (and most of them I knew I was allergic to from experience, so for me skin tests were accurate but blood test were not accurate).

    Since developing asthma and a severe allergic disease I have also become anaphlactic to foods high in sulfites, which is almost all seafood, plus many dried fruits, so that might also be a possibility if you are testing negative to the seafood itself on an ige test it might be the sulfite or a preservative.

    I have also heard of non-IgE mediated allergies before in my research. A lot of the times they will have more of a delay between ingesting them and the reaction, and the reaction can often be more gastrointestinal and atopic, at least at first, so it can be harder to identify it.

     I did come across this study that might be informative on some non-Ige mediated allergies:

     

    Its conclusion is:

    "Non-IgE-mediated food reactions are being reported with increasing frequency. Reactions can vary from flaring of atopic dermatitis (AD) to food-induced protein enterocolitis syndrome (FPIES). The exact mechanism is unknown, but most studies suggest a T cell-mediated pathophysiology, as food-specific T cells can be identified in FPIES and AD patients. One of the most difficult problems in identifying and treating non-IgE-mediated reactions is the lack of standardized testing protocols and the difficulty of obtaining an accurate clinical history. Atopy patch testing may be a promising method for identifying causative foods and has shown progress in EE and AD cases. Additional clinical and translational research is needed in this field to further our knowledge of non-IgE-mediated food reactions."

    So, I guess questions would be, is it worth doing a skin prick test/atopy patch tests on suspected allergens instead of blood test to identify culprits?, is there a test for sulfite sensitivity/allergy? Are there other ways such as keeping a detailed food journal? How does this allergy relate to trouble with vaccines?

  • K8sMom2002

    Good point, Shea, about different things influencing allergy test results. Brian, false negatives are less common than false positives in food allergy testing, but you can be allergic to a food and not test positive for it.

    Our allergist says that reactions trump tests results … here's more information from Kids With Food Allergies (AAFA's food allergy division) on 

    And for even more detail on , here's a great video:

  • Kathy P

    Hi @emtwallace - it sounds like your doctor is looking into an immune deficiency. There are several hundred different types of immune deficiency which are classified by the way they manifest. A good place to start is the Immune Deficiency Foundation – primaryimmune.org

    Many of the types of PI (primary immune deficiency) have a lung involvement component. 

  • K8sMom2002
    emtwallace posted:

    I don't meet with my doctor for another month but was advised to get a pneumonia vaccine asap and just trying to educate myself on this so I can narrow down some of the questions I have when we do meet.

    Brian, have you had a chance to get your yet? Have you found some good sources of info about immune deficiency? Kathy's info above sounds like a really good place to start.