IGE Blood test results in severe asthma?

[My_fairy]

Does anyone know if it’s ok to have normal full count IGE levels in severe asthma? Do they shoot up in exacerbations? What tests you need to prove severe asthma in tertiary centres?I believe Synacthen is one of them to check steroid resistance is there any other specific to check once having exacerbation through skin prick?

[Lysistrata Administrator Community Ambassador]

I'd assume IgE would only be raised in severe allergic asthma, not any type of severe asthma. Even then if someone is on antihistamines or Xolair, which targets IgE, it might not be. Plus people may have allergic asthma plus another type of asthma, so IgE and other allergic markers could be normal because the trigger wasn't allergic.

For those reasons I wouldn't have thought any of these tests are a good test for whether someone is having an exacerbation right that moment. It's kind of 'all roads lead to Rome' -a lot of different mechanisms can cause the same end result of narrowed and inflamed airways so no one should really be using tests like allergic markers or eosinophil count or exhaled nitric oxide (FENO) to say if someone is having an attack or not.

For an exacerbation it would be things like: peak flow (if that's something that drops reliably), oxygen sats (ditto - normal doesn't mean no attack as you probably know), work of breathing, blood gasses, wheeze (again not essential) or reduced air movement.

The synacthen test is just to check how the adrenal glands are working and whether the body can produce cortisol - not whether steroids are working for asthma. It has nothing to do with asthma directly, but obviously might be used if someone has been on a lot of steroids and there's concern their adrenals aren't working properly.

I have a feeling you're asking this because someone has said that normal IgE means no asthma/not having an attack? If so, this page may be useful. These are more diagnostic tests in general, not necessarily to show if someone is having an attack or not. And of course they're not relevant to everyone as things like eosinophils aren't always raised for everyone with asthma and steroids can suppress them (you may already know this!)

asthmaandlung.org.uk/condit...

Hope this helps - it may also be helpful to chat through with the nurses on the helpline if you have specific questions about how the tests are being used: 0300 2225800 or WhatsApp on 07999 377 775 Monday-Friday 0915-5pm

[My_fairy in reply to Lysistrata]

Thanks Lysistrata! It was great help and yes I was talking about allergic asthma. Peak flows in attacks are 50% or less definitely it’s asthma but we struggled a lot although it’s been proven by bloods. I just wanted some information and you are always spot on.

Hope you are doing well. Take care of yourself. You are a genuine soul and really appreciate how you help and spread knowledge on this subject.

Best wishes

[Lysistrata Administrator Community Ambassador in reply to My_fairy]

Thanks My_fairy - glad it helped and hope the information gets through to whoever needs to be paying attention to it!

You're always welcome -as you know I've struggled with misinformation etc and find it very frustrating, so always glad to share what I know in case it's helpful!

[runcyclexcski in reply to Lysistrata]

>>>Even then if someone is on antihistamines or Xolair, which targets IgE, it might not be.

I agree. I am on Xolair and steroids, and yet my antigen-specific IgEs are still high. I do not think they use the data to tell how severe asthma is; they go with symptoms and with the lung function. The only blood parameter that responds to treatment are eosinophiles -- they go to 0.0 on steroids :).

[My_fairy in reply to runcyclexcski]

yes dust allergy ones she’s positive but overall total level they said is normal. I don’t know how it works but symptoms are very bad and lung function is normally bad in attacks and improves massively with inhaler which is a good thing but keeps getting low throughout the day when she’s uncontrolled she has frequent exacerbations out of nowhere daily.

[runcyclexcski in reply to My_fairy]

>>>overall total level they said is normal.

Did they mean the total IgE or only the dust mite-specific IgE? The latter could be high, even though the total one may not be.

[My_fairy in reply to runcyclexcski]

yes that’s right dust ones are high and the total is normal.

[Jolu29]

Hi I have high allergys in dust and cats but my ige are normal under severe asthma clinic, it's pain as if they were higher then your taken more seriously for biologics , rather than lots anthestimines, I have to wear mask at home dusting still feel it the next day on my chest.

[My_fairy in reply to Jolu29]

Yes she’s dust allergy too they are high but total ones are normal. I didn’t know that’s how they consider biologics she did receive Zolair but she got immune to it within 4-5 months so it’s stopped working proving severe asthma. She met the high criteria of 2 acute asthma attacks and lots of steroid use also high inflammation but we are now reluctant to try another one as it might be a failure again and trying other things which have atleast improved quality of life that she’s able to go to school but stil gets random attacks which I think are kind of impossible to control and they can be life threatening. Her asthma is way too complex and therapy resistant. That’s why I was checking is it possible that IGE levels to raise when you experience an exacerbation. Thanks for the reply.

[MMBJI in reply to Jolu29]

We vacuum daily (floors) and vacuum all ledges/surfaces weekly with a dusty brush attachment (our name for it - not a technical term.) Vacuuming the dust away, rather than traditional “dusting” helps a lot to prevent the dust being disturbed and moved into the air- therefore minimising the amount that reaches our respiratory system. 😜