Significance of total serum IgE in children with lower respiratory infections due to respiratory syncytial virus

Yoon Young Jang; Hyun Seok Lee; Ji Eun Jeong; Suk Jin Hong; Hye Jin Park; Kye Hyang Lee; Wootaek Kim; Hai Lee Chung

doi:10.4168/aard.2016.4.2.126

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Jang, Lee, Jeong, Hong, Park, Lee, Kim, and Chung: Significance of total serum IgE in children with lower respiratory infections due to respiratory syncytial virus

Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(2): 126-132.

Published online: 31 March 2016

DOI: https://doi.org/10.4168/aard.2016.4.2.126

Significance of total serum IgE in children with lower respiratory infections due to respiratory syncytial virus

Yoon Young Jang, Hyun Seok Lee, Ji Eun Jeong, Suk Jin Hong, Hye Jin Park, Kye Hyang Lee, Wootaek Kim, Hai Lee Chung

Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea.

Correspondence to: Hai Lee Chung. Department of Pediatrics, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea. Tel: +82-53-650-4245, Fax: +82-53-623-7507, hlchung@cu.ac.kr

Received 17 September 2015 Revised 18 December 2015 Accepted 22 January 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Purpose

Respiratory syncytial virus (RSV) is known to induce Th2 immune response with increased IgE production. We investigated serum IgE levels in RSV bronchiolitis/pneumonia (RSV-LRI) in relation to disease severity.

Methods

One hundred seven children admitted with RSV-LRI were enrolled. The patients were divided into 2 groups according to serum IgE levels: the high IgE (n=39, more than 2 standard deviations from the mean levels for age-matched controls) and low IgE groups (n=68). We investigated if there were any differences in clinical and laboratory findings, and recurrence of wheezing between the 2 groups. The difference in IgE levels between severe (severity score≥3) and nonsevere groups was also studied.

Results

More frequent and prolonged fever was observed in the high IgE group than in the low IgE group (P<0.05). Patients showing severe symptoms or respiratory difficulties were more frequently seen in the high IgE group (P=0.01). There was no difference in parental allergy and atopic sensitization. The nearly same findings were observed in reanalysis of data from patients with the first RSV-LRI, but recurrence of wheezing was significantly higher in the high IgE group than in the low IgE group (P=0.04). Patients with high IgE levels were more frequently seen in severe patients than in nonsevere patients (P=0.01).

Conclusion

Our study showed that children who presented with high serum IgE levels during RSV infections had more severe symptoms compared to those with low IgE levels. It suggests that measurement of total serum IgE levels might be helpful in evaluating disease severity and recurrent wheezing in children admitted with RSV-LRI.

Keywords: Respiratory syncytial viruses, IgE, Bronchiolitis

Figures and Tables

Table 1

Clinical findings in relation to serum IgE levels in patients with RSV LRI

Variable	High IgE group (n = 39)	Low IgE group (n = 68)	P-value
Age (mo)	17 (8-25)	7 (3-11)	0.001
Male sex	27 (69)	12 (43)	0.01
Total serum IgE (IU/mL)	149.0 (103.0-257.0)	6.1 (2.4-14.8)	0.001
Parental allergic disease	16 (41)	29 (43)	0.87
Atopic dermatitis	3 (8)	1 (2)	0.1
Atopic sensitization	9/21 (43)	3/16 (19)	0.12
Food allergy	1/21 (5)	1/16 (6)	0.91
Past history of LRI	16 (41)	15 (22)	0.04
Fever	25 (64)	27 (40)	0.02
Duration of fever (day)	2 (0-3)	0 (0-1)	0.01
Symptom score ≥ 3	16 (41)	13 (19)	0.01
O2 saturation < 93%	7 (18)	7 (10)	0.26
Tachypnea/chest retraction	29 (74)	33 (49)	0.01
Wheezing	32 (82)	60 (88)	0.38
Duration of hospitalization (day)	8 (5-9)	7 (6-8)	0.94
Follow-up duration (mo)	15 (7-19)	9 (6-20)	0.18
Recurrent wheezing during follow-up	14 (36)	16 (24)	0.17
Total WBC count (×10³/µL)	10,600 (6,900-13,000)	9,350 (7,850-12,075)	0.70
Eosinophil count (/mL)	59 (12-171)	117 (32-245)	0.40
CRP (mg/L)	5.8 (4.8-13.4)	4.8 (2.8-8.7)	0.09

Values are presented as median (interquartile range) or number (%).

RSV, respiratory syncytial virus; LRI, lower respiratory infection; WBC, white blood cell; CRP, C-reactive protein.

Table 2

Clinical findings in relation to serum IgE levels in patients with the 1st RSV LRI

Variable	High IgE group (n = 23)	Low IgE group (n = 53)	P-value
Age (mo)	15 (6-24)	5 (2-8)	0.001
Male sex	14 (61)	21 (40)	0.09
Total serum IgE (IU/mL)	125.1 (75.5-215.0)	4.1 (2.2-11.9)	0.001
Parental allergic disease	9 (39)	22 (42)	0.85
Atopic sensitization	3/12 (25)	3/10 (30)	1.00
Fever	14 (61)	19 (36)	0.04
Duration of fever (day)	2.5 (0-4)	0 (0-1)	0.01
Symptom score ≥ 3	9 (39)	9 (17)	0.04
O2 saturation < 93%	5 (22)	5 (9)	0.15
Tachypnea/chest retraction	17 (74)	23 (43)	0.01
Wheezing	18 (78)	47 (89)	0.24
Duration of Hospitalization (day)	7 (5-9)	7 (6-8)	0.89
Follow-up duration (mo)	15 (7-19)	8 (6-25)	0.34
Recurrent wheezing during follow-up	7 (30)	6 (11)	0.04
Total WBC count (×10³/µL)	9,300 (6,400-12,200)	8,900 (8,000-11,350)	0.73
Eosinophil count (/mL)	85 (18-322)	131 (44-244)	0.99
CRP (mg/L)	4.8 (4.8-12.4)	4.8 (2.7-8.6)	0.36

Values are presented as median (interquartile range) or number (%).

RSV, respiratory syncytial virus; LRI, lower respiratory infection; WBC, white blood cell; CRP, C-reactive protein.

Table 3

Clinical findings in relation to symptom score in patients with RSV LRI

Variable	Symptom score ≥ 3 (n = 29)	Symptom score ≤ 2 (n = 78)	P-value
Age (mo)	17 (5-23)	5 (2-16)	0.01
Male sex	16 (55)	40 (51)	0.72
No. of high IgE patients^*	16 (55)	23 (30)	0.01
Parental allergic disease	13 (45)	49 (63)	0.09
Atopic sensitization	5/14 (36)	7/23 (30)	1.00
Past history of LRI	11 (38)	20 (26)	0.21
Recurrent wheezing during follow-up	14 (48)	16 (21)	0.01
Total WBC count (/mL)	8,900 (6,800-12,550)	9,800 (7,800-12,600)	0.37
Eosinophil count (/mL)	56 (9-143)	107 (30-285)	0.04
CRP (mg/L)	9 (5-14)	5 (4-8)	0.04

Values are presented as median (interquartile range) or number (%).

RSV, respiratory syncytial virus; LRI, lower respiratory infection; WBC, white blood cell; CRP, C-reactive protein.

^*No. of patients who belong to high IgE group.

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ORCID iDs: Hai Lee Chung
https://orcid.org/http://orcid.org/0000-0002-5364-5318
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