Asthma Immunoglobulin E (IgE) and Allergic Asthma By Pat Bass, MD twitter linkedin Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians. Learn about our editorial process Pat Bass, MD Medically reviewed by Medically reviewed by John Carew, MD on July 02, 2020 twitter linkedin John Carew, MD, is board-certified in otolaryngology-head and neck surgery. He is an adjunct assistant professor at Mount Sinai Medical Center and NYU Medical Center. Learn about our Medical Review Board John Carew, MD on July 02, 2020 Print Table of Contents View All The Role of IgE Symptoms Diagnosis Treatment Asthma can be described as allergic or non-allergic. Allergic (extrinsic) asthma is associated with immunoglobulin E (IgE)—an antibody generated by the immune system, in this case, in response to a normally harmless substance. In contrast, non-allergic (intrinsic) asthma episodes are not typically triggered by exposure to a substance and are not associated with IgE. Given the role of IgE in certain asthma cases, treatment may involve an anti-IgE medication to lower amounts of this antibody and its effects. A blood test to check your levels can help determine whether this may or may not be useful in your case. Philippe Roy / Getty Images The Role of IgE IgE is naturally produced by B cell lymphocytes, a type of immune white blood cell. This antibody normally activates physical responses to help your body fight infections. For some people, exposure to allergens—which are harmless, non-infectious substances (like dust or pollen)—can also trigger the body to produce and release IgE. In these situations, IgE antibodies bind to the allergen and trigger an inflammatory response that can manifest with allergy symptoms such as a skin rash, sneezing, and swollen lips. When it results in asthma, it is considered the allergic type. Common allergens include: Animal danderCockroachesDust mitesMoldsPollen When your body releases IgE, a cascade of immune responses follows, some of which are mediated by other immune cells in the body. IgE is believed to bind to and activate several types of immune cells, such as: BasophilsLymphocytesMast cells When IgE binds with any of these cells, it can overstimulate your immune system. Additionally, your capillaries widen and become leakier, increasing inflammation by allowing the immune cells to cluster around the allergen. Symptoms Caused by Excess IgE When you have allergic asthma, your bronchi (airways) can become narrow and inflamed due to the rush of immune cells—and this rapidly exacerbates your asthma symptoms. Not only do the inflammatory cells prevent air from passing through your airways, but your airways may also suddenly spasm, making it difficult for air to pass as you try to breathe. Increased levels of IgE may contribute to symptoms of asthma, such as: WheezingChest tightnessShortness of breathRecurrent cough The symptoms are usually mild, but they can be quite severe and may cause serious consequences, such as a life-threatening respiratory crisis. Asthma Symptoms Diagnosis If have not yet been formally diagnosed with asthma, your doctor will review your specific symptoms. Those that suggest an allergic cause of your asthma include itchy eyes, nausea, sneezing, coughing, and congestion. Sometimes the pattern of symptoms can point to allergic asthma when symptoms tend to occur in relation to allergen exposure. Allergy testing can help identify what may be triggering your condition. IgE Testing If there is a concern that you have allergic asthma, your doctor might test your IgE level to help make a diagnosis and to help guide your treatment plan. Your doctor will consider your results in the context of your symptoms and other diagnostic measures. Your antibody level can vary, and your IgE level might be normal even if you have allergic asthma. A high IgE level can't confirm a diagnosis of asthma. High IgE can only suggest that you may have some sort of allergic disorder. Immune disorders and infection due to a parasite are also associated with high levels of IgE. For example: Churg-Strauss syndrome, a type of vasculitis (inflammation of the blood vessels)Allergic bronchopulmonary aspergillosis, a hypersensitivity to a soil fungus known as Aspergillus fumigatus Children who have asthma are more likely to have elevated IgE levels than adults with asthma. Asthma that begins for the first time during adulthood, called adult-onset asthma, is more likely to be intrinsic, non-allergic asthma. An elevated IgE level supports the diagnosis of allergic asthma but does not give an indication of what the trigger(s) of your attacks could be. Treatment There are a number of treatments for allergic asthma, including avoiding allergens that are asthma triggers, if possible. However, it is not always possible to avoid allergens, especially if they are highly prevalent in the environment. Inhalers containing immunosuppressants or bronchodilators are commonly used to treat allergic asthma. Treatment with anti-IgE is another approach that can be used along with bronchodilators. Your IgE level can help your doctor determine whether you might benefit from treatment that can lower IgE. But a high level is not a requirement for treatment with an anti-IgE. Your doctor might consider this if your asthma is persistent or if you have side effects from your treatment. Reducing your IgE, if elevated, is a more targeted method of preventing symptoms of allergic asthma than immunosuppression with steroids, which has long been a way of managing asthma by reducing inflammation. Xolair (omalizumab) is an anti-IgE medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of allergic asthma for adults and children over the age of 6. It binds to IgE antibodies to reduce their effects and help prevent (though not treat) allergic asthma attacks. Indications for Xolair include: Severe or persistent asthma that's inadequately controlled with inhaled corticosteroids and a positive skin test or positive blood allergy testChronic skin rash that's inadequately controlled with antihistamines Xolair is given every two to four weeks as a subcutaneous (under the skin) injection administered by a healthcare provider. Side effects can include injection site reactions, infections, headaches, and sore throat. Xolair for the Treatment of Asthma A Word From Verywell Allergic asthma is caused by an overreaction to one or more specific allergens, and you are likely to experience symptoms every time you are exposed to them. High levels of IgE can support a diagnosis of allergic asthma, and anti-IgE medication may help control your symptoms. If you are already on an allergic asthma treatment plan without adequate control of your asthma, speak with your doctor about your persistent symptoms. You may benefit from revising your treatment approach. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Matucci, A., Vultaggio, A., Maggi, E. et al. Is IgE or eosinophils the key player in allergic asthma pathogenesis? Are we asking the right question? Respir Res 19, 113 (2018) doi:10.1186/s12931-018-0813-0 Matsumoto M. In vivo assay of IgE activities on the expulsion of intestinal adult worms. Parasitol Int. 2016;65(5 Pt B):506-509.doi:10.1016/j.parint.2016.02.005 Asthma and Allergy Foundation of America. Consumer Information. IgE's role in allergic asthma. Updated September 2015 Warrington, R., Watson, W., Kim, H.L. et al. An introduction to immunology and immunopathology. All Asth Clin Immun 7, S1 (2011) doi:10.1186/1710-1492-7-S1-S1 Froidure A, Mouthuy J, Durham SR, Chanez P, Sibille Y, Pilette C. Asthma phenotypes and IgE responses. Eur Respir J. 2016;47(1):304-19. doi:10.1183/13993003.01824-2014 Oettgen HC. Fifty years later: emerging functions of IgE antibodies in host defense, immune regulation, and allergic diseases. J Allergy Clin Immunol. 2016;137(6):1631-1645. doi:10.1016/j.jaci.2016.04.009 Pakkasela J, Ilmarinen P, Honkamäki J, et al. Age-specific incidence of allergic and non-allergic asthma. BMC Pulm Med. 2020;20(1):9.doi:10.1186/s12890-019-1040-2 Amarasekera M. Immunoglobulin E in health and disease. Asia Pac Allergy. 2011;1(1):12-5. doi:10.5415/apallergy.2011.1.1.12 U.S. Food and Drug Administration. Xolair labeling. Published July 2016 Additional Reading Ohta K, Nagase H, Suzukawa M, Ohta S. Antibody therapy for the management of severe asthma with eosinophilic inflammation. Int Immunol. 2017 Jul 1;29(7):337-343. doi:10.1093/intimm/dxx045 Patelis A, Alving K, Middelveld R, et al. IgEsensitization to food allergens and airborne allergens in relation to biomarkers of type 2 inflammation inasthma. Clin Exp Allergy.2018 May 10. doi:10.1111/cea.13165. [Epub ahead of print] National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma