Serum Polyclonal Immunoglobulin E Levels among an Apparently Healthy Iraqi Population: A Preliminary Report
From the Department of Community Medicine (Drs. Al-Diwan and Al-Hadithi) and Department of Microbiology (Dr. Al-Balaghi), College of Medicine, University of Baghdad, and Central Public Health Laboratory, Ministry of Health (Dr. Al-Khadriy), Baghdad, Iraq.
JKA Al-Diwan, TSA Al-Hadithi, SMA Al-Balaghi, W Al-Khadriy, Serum Polyclonal Immunoglobulin E Levels Among an Apparently Healthy Iraqi Population: A Preliminary Report. 1989; 9(2): 154-157
Abstract
The distribution of serum polyclonal IgE levels as determined by paper radioimmunosorbent test was studied in 150 nonallergic, presumably healthy individuals. Prior to natural logarithmic conversion, the distribution was strongly skewed to the left, and normal distribution followed logarithmic conversion. The range of serum polyclonal IgE levels was 1 to 2439 μg/L with a geometric mean value of 197 μg/L. Regression analysis of natural logarithm of serum polyclonal IgE levels with age revealed no significant association. Higher levels were demonstrated among individuals 10 to 14 years old than among other age groups. No influence of sex on serum polyclonal IgE was demonstrated.
Immunoglobulin E is normally present in extremely small amounts.1 In the years following the identification of IgE by Ishizaka and Ishizaka2 and Johansson and Bennich,3 many authors documented a wide range of values in variously defined groups.4-6
Several authors have shown elevated serum IgE levels in patients with atopy7,8 and helminthiasis.9-12 Other diseases associated with increased total serum IgE levels include Hodgkin's disease,13 cancer,14 skin disease,15 ß-thalassemia,16 Wiskott-Aldrich syndrome,17 acute graft-versus-host disease,18 and viral diseases.19-21 Elevated serum polyclonal IgE levels have also been demonstrated in smokers.22,23
Variation of IgE levels among individuals and patients stemmed from differences in race,24 age and sex,6,25,26 assay methods,27 and other factors including infections. Discrepancies in various studies may be due to poor definition of the study population, variability of environmental factors, use of nonstandardized reagents, and different statistical methods.
This study is a preliminary report on the serum polyclonal IgE levels in a nonallergic presumably healthy Iraqi urban population.
Methods
Venous blood samples were obtained from 150 apparently healthy subjects attending Al-Waih Pediatric Hospital to vaccinate their children. They gave no history of allergy, and their stool and urine examination revealed no helminthic infection. The mean age of these individuals was 26 ± 14.5 years (ranging from 8 months to 65 years) with a male-to-female ratio of 1.3:1.
Sera were separated from clotted blood by cen-trifugation, divided into aliquots, and stored at –20°C. Serum polyclonal IgE levels were determined by paper radioimmunosorbent test as described by Gleich et al,28 using commercially available kits. Serum samples were assayed in duplicate within the same batch, and the values recorded were the mean of two determinations. In brief, anti-IgE coated filter paper disks were incubated overnight with test serum. After three washings, each disk was incubated with anti-IgE-125I. After three more washings, the radioactivity percent on each disk was measured in a gamma counter. Results were expressed as percentage binding (the ratio between count per minutes of each disk and total radioactivity).
The results were evaluated statistically by the Student t test and analysis of variance. P values less than 0.05 were considered statistically significant.
Results
The frequency distribution of serum polyclonal IgE was strongly skewed to the left (Figure 1) with almost 31.3% of values below 120 μg/L. The data were transformed to natural logarithm to get a normal distribution (Figure 2).
The range of serum polyclonal IgE was found to be 1 to 2439 μg/L with a geometric mean value of 197 μg/L.
Regression analysis of natural logarithm figures of serum polyclonal IgE levels with age revealed no significant association (Figure 3). Analysis of serum polyclonal IgE levels at 15-year intervals revealed significantly higher levels of serum polyclonal IgE among individuals less than 15 years old than other age groups (P < 0.005) (Table 1). Further analysis of serum levels at 5-year intervals among subjects below 15 years of age revealed significantly higher levels in those aged 5 to 14 years than in those below 5 years of age (P < 0.05) (Table 2).
Table 1. Age distribution of means of serum polyclonal IgE.
|
Age (y) |
||||
|
|
≤1–14 |
15–29 |
30–44 |
45–59 |
|
No. of |
32 |
57 |
42 |
19 |
|
Geometric mean (μg/L) |
355 |
161 |
161 |
197 |
|
LnIgE |
5.87±1.80 |
5.08±2.60 |
5.28±2.27 |
5.28±2.17 |
Table 2. Mean serum polyclonal IgE levels in individuals below 15 years of age.
|
Age (y) |
|||
|
|
≤1–4 |
5–9 |
10–14 |
|
No. of |
10 |
15 |
7 |
|
Geometric |
106 |
356 |
480 |
|
LnIgE |
4.66±2.30 |
5.87±2.40 |
6.17±1.67 |
Figure 4 illustrates that the serum polyclonal IgE levels were low in young children below 5 years of age, increasing to a maximum level at the age group 10 to 14 years old, then declining rapidly after the age of 15 years to a relatively stable adult level. Another peak was observed over 50 years of age.
A statistically significant influence of sex on the values of serum polyclonal IgE could not be demonstrated (P > 0.05).
Discussion
The discovery of IgE has opened possibilities for the development of diagnostic procedures in allergy and other diseases. It has predictive values in small children with hereditary predisposition as well.29 Several authors have attempted to define normal levels and ranges in nonatopic "healthy" populations. However, the precise normal levels of serum IgE are difficult to determine as there are several factors affecting the level.
The mean value of serum polyclonal IgE in healthy Iraqi individuals (197 μg/L) is in accordance with the finding of Abdulla and Ghani,30 who reported a value of 72 ± 3.8 IU/mL (173 ± 9 μg/L). Differences in environmental factors may partially or completely explain other differences in serum total IgE levels,25,32-34 reported from other parts of the world, and genetic factors have been found to effect serum IgE levels as well.35-37
The maximum level of serum polyclonal IgE was at 10 to 14 years of age. This finding is consistent with that of Barbee et al25 who reported the maximum level at the age of 6 to 14 years and Stoy et al26 who reported a maximum level at 14 years of age. Grundbacher and Massie32 found the maximum level below the age of 10 years. No explanation could be given for the peak after 50 years of age.
No sex influence on the IgE levels could be demonstrated in the current study, a finding that concurs with some reports29,32,38 and conflicts with others.30,39-41
Acknowledgment
We are grateful to Dr. N. S. Al-Asadi for supplying the blood samples, and for the staff of Atomic Energy Center for supplying isotope materials.
References
1. Roitt IM. Essential immunology. 5th ed. London: Blackwell Scientific Publications, 1984:40.
2. Ishizaka K, Ishizaka T. Identification of gamma-E-anti-bodies as carrier of reaginic activity. J Immunol 1967;99:1187-98.
3. Johansson SG, Bennich H. Immunological studies on an atypical (myeloma) immunoglobulin. Immunology 1967;13:381-94.
4. Johansson SG. Serum IgND levels in healthy children and adults. Int Arch Allerg 1968;34:1-8.
5. Nye L, Merrett TG, Landon J, White RJ. A detailed investigation of circulating IgE levels in a normal population. Clin Allergy 1975;1:13-6.
6. Grundbacher FJ. Causes of variation in serum IgE levels in normal populations. J Allergy Clin Immunol 1975;56(2): 104-11.
7. Johansson SG. Raised levels of new immunoglobulin class (IgND) in asthma. Lancet 1967;2:951-3.
8. Spitz E, Gelfand EW, Sheffer AL, et al. Serum IgE in clinical immunology and allergy. J Allergy Clin Immunol 1972;49:337-47.
9. Johansson SG, Melbin T, Vahlquist B. Immunoglobulin levels in Ethiopian preschool children with special reference to high concentrations of immunoglobulin E (IgND). Lancet 1968;1:1118-21.
10. Hogarth-Scott RS, Johansson SG, Bennich H. Antibodies to Toxocara in the sera of visceral larva migrans patients: the significance of raised levels of IgE. Clin Exp Immun 1969;5:619-25.
11. Dessaint JP, Bout D, Wattre P, Capron A. Quantitative determination of specific IgE antibodies to Echinococcus granulosus and IgE levels in sera from patients with hydatid disease. Immunology 1975;29:813-23.
12. Knight R, Merrett TG. Hookworm infection in rural Gambia: seasonal changes, morbidity and total IgE levels. Ann Trop Med Parasitol 1981;75(3):299-314.
13. Amlot PL, Green LA. Atopy and immunoglobulin E concentrations in Hodgkin's disease and other lymphomas. Br Med J 1978;1:327-9.
14. Jacobs D, Landon J, Houri M, et al. Circulating levels of immunoglobulin E in patients with cancer. Lancet 1972;2:1059-61.
15. Juhlin L, Johansson SG, Bennich H, et al. Immunoglobulin E in dermatoses: levels in atopic dermatitis and urticaria. Arch Dermatol 1969;100:12-6.
16. Vierucci A, De Martino M, Rossi ME, Vullo C, et al. Raised IgE levels in ß-thalassaemia: correlation with splenectomy and hepatitis B virus infection. Clin Exp Immunol 1984;58:199-205.
17. Remold-O'Connell E, Kenney DM, Parkman R, et al. Characterization of a human lymphocyte surface sialog-lycoprotein that is defective in Wisckott-Aldrich syndrome. J Exp Med 1984;159:1705-23.
18. Ringden O, Persson U, Johansson SG, et al. Markedly elevated serum IgE levels following allogeneic and syngeneic bone marrow transplantation. Blood 1983;61(16):1190-5.
19. Bahna SL, Horwitz CA, Fiala M, Heiner DC. IgE response in heterophil-positive infectious mononucleosis. J Allergy Clin Immunol 1978;62(3): 167-73.
20. Peremutter L, Potvin L, Phipps P. Immunoglobulin E response during viral infection. J Allergy Clin Immunol 1978;64(2): 127-30.
21. Griffin DE, Cooper SJ, Hirsh RL, et al. Changes in plasma IgE levels during complicated and uncomplicated measles virus infection. J Allergy Clin Immunol 1985;76:206-13.
22. Burrows B, Halonen M, Barbee RA, Lebowitz MD. The relationship of serum immunoglobulin E to cigarette smoking. Am Rev Respir Dis 1981;124(5):523-5.
23. Zetterstrom O, Osterman K, Machado L, Johansson SGO. Another smoking hazard: raised IgE concentration and increase risk of occupational allergy. Br Med J 1981;283:1215-7.
24. Orgel HA, Lenoir MA, Bazaral M. Serum IgG, IgA, IgM, and IgE levels and allergy in Filipino children in the United States. J Allergy Clin Immunol 1974;53:213-22.
25. Barbee RA, Halonen M, Lebowitz M, Burrows B. Distribution of IgE in a community population sample: correlations with age, sex, and allergin skin test. J Allergy Clin Immunol 1981;68(2):106-11.
26. Stoy PJ, Roitman-Johnson B, Walsh G, et al. Aging and serum immunoglobulin E levels, immediate skin test, RAST. J Allergy Clin Immunol 1981;68(6):421-6.
27. Adkinson MF. Measurement of total serum IgE antibody. In: Rose INF, Friedman H, eds. Manual of clinical immunology. Washington DC: American Society for Microbiology, 1970:590.
28. Gleich GJ, Averbeck AK, Swedlund HA. Measurement of IgE in normal and allergic serum by radioimmunoassay. J Lab Clin Med 1971;77:690-8.
29. Lindberg RE, Arroyave C. Levels of IgE in serum from normal children and allergic children as measured by enzyme immunoassay. J Allergy Clin Immunol 1986;78:614-8.
30. Abdulla BA, Ghani HM. Estimation of total serum IgE in normal Iraqi subjects. J Fac Med Baghdad 1986;28(2):3-9.
31. Abdulla B. Atopic allergy to some prevalent fungi in Mosul: correlation between total serum IgE and skin test (thesis), Mosul University, 1983.
32. Grundbacher FJ, Massie FS. Levels of immunoglobulin G, M, A, and E at various ages in allergic and nonallergic black and white individuals. J Allergy Clin Immunol 1985;75(6):651-8.
33. Dasgupta A, Lal M. Immunoglobulins in health and disease. II. IgE concentrations in sera of patients with bronchial asthma. Indian J Med Res 1974;62:1607.
34. El-Asfahani AMA, Yousef A, Zahran F, Hashash M. Serum IgE levels in normal Saudi adults and patients with clinical allergic rhinitis. King Abdulaziz Med J 1982;2(l):23-33.
35. Bazaral M, Orgel HA, Hamburger N. Genetics of IgE and allergy: serum IgE levels in twins. J Allergy Clin Immunol 1974;54(5):288-304.
36. Orgel HA, Hamburger RN, Bazaral M, et al. Development of IgE and allergy in infancy. J Allergy Clin Immunol 1975;56(4):296-307.
37. Blumenthal MN, Yunis E, Mendell N, Elston RC. Preventive allergy: genetics of IgE-mediated diseases. J Allergy Clin Immunol 1986;78:962-8.
38. Kaplan JE, Larrick JW, Yost JA. Hyperimmunog-lobulinemia E in the Waorani, an isolated Amerindian population. Am J Trop Med Hyg 1980;29(5):1012-7.
39. Zegers BJ, Stoop JW, Reerink-Brongers EE, et al. Serum immunoglobulins in healthy children and adults: levels of the five classes, expressed in international units per millilitre. Clin Chim Acta 1975;65(3):319-29.
40. Wittig HJ, Belloit J, DeFillipi I, Royal G. Age-related serum immunoglobulin E levels in healthy subjects and in patients with allergic disease. J Allergy Clin Immunol 1980;66(4):305-13.
41. Heese HD, du Plessis JM, Dempster WS, et al. Serum IgE levels in rural Nambian infants. J Allergy Clin Immunol 1984;74:514-23.
Print version 
Plain text 
