immunoglobulin E

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immunoglobulin E

n. Abbr. IgE
The class of antibodies produced in the lungs, skin, and mucous membranes and responsible for allergic reactions.

immunoglobulin E (IgE)

one of the five classes of antibodies produced by the body. It is concentrated in the lungs, skin, and mucous membranes. It provides the primary defense against environmental antigens and is believed to be responsive to immunoglobulin A. IgE reacts with certain antigens to trigger the release of chemical mediators that cause anaphylactic hypersensitivity reactions characterized by wheal and flare. The normal concentration of IgE in serum is 0.01 to 0.04 mg/dL. Compare immunoglobulin A, immunoglobulin D, immunoglobulin G, immunoglobulin M.

Immunoglobulin E (IgE)

A type of protein in blood plasma that acts as an antibody to activate allergic reactions. About 50% of patients with allergic disorders have increased IgE levels in their blood serum.

Immunoglobulin E

Synonym/acronym: IgE.

Common use

To assess immunoglobulin E (IgE) levels in order to identify the presence of an allergic or inflammatory immune response.

Specimen

Serum (1 mL) collected in a gold-, red-, or red/gray-top tube. Place separated serum into a standard transport tube within 2 hr of collection.

Normal findings

(Method: Immunoassay)
AgeConventional & SI Units
NewbornLess than 12 International Units/L
Less than 1 yrLess than 50 International Units/L
2–4 yrLess than 200 International Units/L
5–9 yrLess than 300 International Units/L
10 yr and olderLess than 100 International Units/L

Description

Immunoglobulin E (IgE) is an antibody whose primary response is to allergic reactions and parasitic infections. Most of the body’s IgE is bound to specialized tissue cells; little is available in the circulating blood. IgE binds to the membrane of special granulocytes called basophils in the circulating blood and mast cells in the tissues. Basophil and mast cell membranes have receptors for IgE. Mast cells are abundant in the skin and the tissues lining the respiratory and alimentary tracts. When IgE antibody becomes cross-linked with antigen/allergen, the release of histamine, heparin, and other chemicals from the granules in the cells is triggered. A sequence of events follows activation of IgE that affects smooth muscle contraction, vascular permeability, and inflammatory reactions. The inflammatory response allows proteins from the bloodstream to enter the tissues. Helminths (worm parasites) are especially susceptible to immunoglobulin-mediated cytotoxic chemicals. The inflammatory reaction proteins attract macrophages from the circulatory system and granulocytes, such as eosinophils, from circulation and bone marrow. Eosinophils also contain enzymes effective against the parasitic invaders.

A nasal smear can be examined for the presence of eosinophils to screen for allergic conditions. Either a single smear or smears of nasal secretions from each side of the nose should be submitted, at room temperature, for Hansel staining and evaluation. Normal findings vary by laboratory but generally, greater than 10–15% is considered eosinophilia or increased presence of eosonophils. Results may be invalid for patients already taking local or systemic corticosteroids.

This procedure is contraindicated for

    N/A

Indications

  • Assist in the evaluation of allergy and parasitic infection

Potential diagnosis

Increased in

  • Conditions involving allergic reactions or infections that stimulate production of IgE.

  • Alcoholism (alcohol may play a role in the development of environmentally instigated IgE-mediated hypersensitivity)
  • Allergy
  • Asthma
  • Bronchopulmonary aspergillosis
  • Dermatitis
  • Eczema
  • Hay fever
  • IgE myeloma
  • Parasitic infestation
  • Rhinitis
  • Sinusitis
  • Wiskott-Aldrich syndrome

Decreased in

    Advanced carcinoma (related to generalized decrease in immune system response) Agammaglobulinemia (related to decreased production) Ataxia-telangiectasia (evidenced by familial immunodeficiency disorder) IgE deficiency

Critical findings

    N/A

Interfering factors

  • Drugs that may cause a decrease in IgE levels include phenytoin and tryptophan.
  • Penicillin G has been associated with increased IgE levels in some patients with drug-induced acute interstitial nephritis.
  • Normal IgE levels do not eliminate allergic disorders as a possible diagnosis.

Nursing Implications and Procedure

Potential nursing problems

ProblemSigns & SymptomsInterventions
Powerlessness (Related to chronic illness; treatment for illness; loss of ability to provide self-care; progressive debilitation; terminal prognosis)Expression of loss of control over situation, self, outcome of disease; passive; apathetic; submissive; decreased participation in self-care; reluctant to express feelingsAssess need to be in control; assess feelings of hopelessness, depression, apathy; assist to identify situations that contribute to a feeling of powerlessness; assess the impact of the sense of powerlessness on the patient’s sense of self; encourage verbalization of feelings; discuss therapeutic options offered by health-care provider (HCP); assist to identify strengths; identify coping strategies; encourage being responsible for self-care and personal environment to increase sense of control; provide positive feedback
Mobility (Related to pain; weakness; depression; fatigue; decreased muscle strength; decreased coordination)Decreased purposeful movement; difficulty completing activities of daily living; limited range of motion; reluctance to move; painAssess the patient’s ability to perform independent range-of-motion exercises; encourage performance of range-of-motion exercises; encourage and assist in moving every 2 hr to relieve tissue pressure; assist with activities of daily living; encourage use of assistive devices as needed to support mobility
Knowledge (Related to recent diagnosis; complexity of treatment; poor understanding of provided information; cultural or language barriers; anxiety; emotional disturbance; unfamiliarity with medical management)Lack of interest or questions; multiple questions; anxiety in relation to disease process and management; verbalizes inaccurate information; lack of follow-through with directionsIdentify patient’s, family’s, and significant others’ concerns about disease process; provide information about disease process, bone marrow analysis, and associated diagnostic studies that may be necessary (computed tomography [CT], bone scan); facilitate and monitor ordered laboratory studies (CBC, immunoglobulin levels, C-reactive protein [CRP], protein electrophoresis); discuss possible treatment modalities, chemotherapy, proteasome inhibitors, palliative radiation therapy, drug administration, stem cell transplant, pain management

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this test can assist in identification of an allergic or inflammatory response.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s immune and respiratory systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
  • Nutritional Considerations: Increased IgE levels may be associated with allergy. Consideration should be given to diet if the patient has food allergies.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the patient’s condition and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
  • Patient Education

    • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
    • Answer any questions or address any concerns voiced by the patient or family.
    • Explain that a negative result does not necessarily preclude the presence of a sensitivity to an allergen.
  • Expected Patient Outcomes

    • Knowledge
    • Understands the importance of maintaining an uncluttered home environment to decrease injury risk
    • Understands the importance of conserving energy by including frequent rest periods during times of activity
    • Skills
    • Successfully changes position every 2 hr to decrease risk of skin breakdown
    • Demonstrates the ability to perform range-of-motion exercises proficiently
    • Attitude
    • Agrees to accept assistance with activities of daily living to enhance comfort and safety
    • Agrees to perform range-of-motion activities 3 times a day to decrease contracture risk

Related Monographs

  • Related tests include allergen-specific IgE, alveolar/arterial gradient, biopsy intestine, biopsy liver, biopsy muscle, blood gases, carbon dioxide, CBC, CBC platelet count, CBC WBC count and differential, eosinophil count, fecal analysis, hypersensitivity pneumonitis, lung perfusion scan, and PFT.
  • Refer to the Immune and Respiratory systems tables at the end of the book for related tests by body system.