Treatment for Conditions with Elevated Immunoglobulin E (IgE) Levels

Condition-Specific Treatments

Inhaled corticosteroids (ICS) are the cornerstone of therapy for persistent allergic asthma regardless of age group, according to the American Academy of Allergy, Asthma, and Immunology 1
For moderate to severe persistent asthma inadequately controlled with ICS, the American Thoracic Society recommends adding omalizumab (anti-IgE therapy) for patients ≥6 years with positive skin test or in vitro reactivity to perennial aeroallergens 1
For non-severe disease manifestations (asthma/sinonasal disease) with high serum IgE levels, the American College of Rheumatology recommends mepolizumab over omalizumab 2
For patients experiencing relapse while on methotrexate, azathioprine, or mycophenolate mofetil, the American College of Rheumatology recommends adding mepolizumab 3
H1 and H2 receptor blockers are recommended for skin, gastrointestinal, neurologic, cardiovascular, pulmonary, and naso-ocular symptoms in systemic mastocytosis, according to the National Comprehensive Cancer Network 4
Cromolyn sodium is recommended for cutaneous, gastrointestinal, and neurologic symptoms in systemic mastocytosis, according to the National Comprehensive Cancer Network 4
Omalizumab (anti-IgE monoclonal antibody) is particularly effective for recurrent anaphylaxis and skin symptoms in systemic mastocytosis, according to the National Comprehensive Cancer Network 4

No reliable biomarker exists for diagnosis of atopic dermatitis, though elevated total/allergen-specific IgE is common, according to the American Academy of Dermatology 5
High total IgE levels may predict more severe and protracted disease course in atopic dermatitis, according to the American Academy of Dermatology 6

Allergen immunotherapy may be considered for allergic rhinitis and allergic asthma, as it can modify the immune response, according to the American Academy of Allergy, Asthma, and Immunology 7
Successful immunotherapy is associated with a shift to TH1 CD4+ cytokine profile, generation of regulatory T cells producing IL-10 and TGF-β, and increased allergen-specific IgG4 antibodies, according to the American Academy of Allergy, Asthma, and Immunology 7
Increased allergen-specific IgG4 antibodies can block IgE-dependent responses, according to the American Academy of Allergy, Asthma, and Immunology 8