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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Clin+Gastroenterol+Hepatol
2017 ; 15
(9
): 1444-1452.e6
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Increases in IgE, Eosinophils, and Mast Cells Can be Used in Diagnosis and to
Predict Relapse of IgG4-Related Disease
#MMPMID28223204
Culver EL
; Sadler R
; Bateman AC
; Makuch M
; Cargill T
; Ferry B
; Aalberse R
; Barnes E
; Rispens T
Clin Gastroenterol Hepatol
2017[Sep]; 15
(9
): 1444-1452.e6
PMID28223204
show ga
BACKGROUND & AIMS: IgG subclass 4-related disease (IgG4-RD) is characterized by
increased serum levels of IgG4 and infiltration of biliary, pancreatic, and other
tissues by IgG4-positive plasma cells. We assessed the prevalence of allergy
and/or atopy, serum, and tissue IgE antibodies, and blood and tissue eosinophils
in patients with IgG4-RD. We investigated the association between serum IgE and
diagnosis and relapse of this disease. METHODS: We performed a prospective study
of 48 patients with IgG4-RD, 42 patients with an increased serum level of IgG4
with other inflammatory and autoimmune conditions (disease control subjects), and
51 healthy individuals (healthy control subjects) recruited from Oxford, United
Kingdom from March 2010 through March 2014, and followed for a median of 41
months (range, 3-73 months). Serum levels of immunoglobulin were measured at
diagnosis, during steroid treatment, and at disease relapse for patients with
IgG4-RD; levels at diagnosis were compared with baseline levels of control
subjects. Allergen-specific IgEs were measured using the IgE ImmunoCAP. Levels
and distribution of IgG4 and IgE antibodies in lymphoid, biliary, and pancreatic
tissues from patients with IgG4-RD and disease control subjects were measured by
immunohistochemistry. We analyzed data using the Spearman rank correlation and
receiver operating characteristic curves. RESULTS: Serum levels of IgG4 increased
to 1.4 g/L or more, and IgE increased to 125 kIU/L or more, in 81% and 54% of
patients with IgG4-RD, respectively, compared with 6% and 16% of healthy control
subjects (P < .0001). Peripheral blood eosinophilia was detected in 38% of
patients with IgG4-RD versus 9% of healthy control subjects (P = .004). Of
patients with IgG4-RD, 63% had a history of allergy and 40% had a history of
atopy with an IgE-specific response; these values were 60% and 53% in patients
with increased serum levels of IgE (P < .05). Level of IgE at diagnosis >480
kIU/L distinguished patients with IgG4-RD from disease control subjects with 86%
specificity, 36% sensitivity, and a likelihood ratio of 3.2. Level of IgE at
diagnosis >380 kIU/L identified patients with disease relapse with 88%
specificity, 64% sensitivity, and a likelihood ratio of 5.4. IgE-positive mast
cells and eosinophilia were observed in lymphoid, biliary, and pancreatic tissue
samples from 50% and 86% of patients with IgG4-RD, respectively. CONCLUSIONS: In
a prospective study, we associated IgG4-RD with allergy, atopy, eosinophilia,
increased serum levels of IgE, and IgE-positive mast cells in lymphoid, biliary,
and pancreatic tissue. An IgE-mediated allergic response therefore seems to
develop in most patients with IgG4-RD; levels of IgE might be used in diagnosis
and predicting relapse.