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PubMed2006

Disconnection of man and the soil: reason for the asthma and atopy epidemic?

Intense search has been going on to find factors responsible for the asthma and atopy epidemic in Western societies. Attention has increasingly been devoted to environmental saprophytes, which, in addition to gut commensals, might be the major players in the development and fine tuning of immunologic homeostasis. This review outlines current evidence for the role of environmental saprophytes in the development of atopic disease and considers the consequences of urbanization in reducing contacts with soil microorganisms. The major microbial components that have been shown to possess immunomodulatory capacity and their respective Toll-like receptors are also discussed, as are the possible mechanisms underlying the ability of saprophytes to confer protection against atopic disease.

Asthma↗
PubMed2006

Toll-like receptor ligands and atopy: a coin with at least two sides.

Allergic disease prevalence rates have increased dramatically in affluent countries over the last half century. One proposed explanation is that decreased exposures to microbes caused by modern public health practices has led to deficiencies in an important source of immune education and a consequent increase in the risk of pathogenic immune responses to environmental antigens. Recently, it has become clear that innate responses to microbes are mediated in large part by Toll-like receptors (TLRs), which recognize a diverse family of ligands produced by viruses, bacteria, and fungi. In this perspectives article we will review experimental evidence suggesting that TLRs also play a dominant role in innate responses to noninfectious immunostimulatory materials present in environments of daily living. We will further discuss how ligands for different TLRs can polarize the T(H) bias of adaptive responses in opposing directions. Finally, we will consider how TLRs might contribute to the genesis of atopy and the clinical potential of pharmacologic interventions that target TLRs for the prevention and treatment of allergic diseases.

Animals↗
PubMed2006

The atopy patch test in the diagnostic workup of suspected food-related symptoms in children.

BACKGROUND: There is an increasing need to develop test instruments that make oral food challenges superfluous. OBJECTIVE: We sought to study the utility of atopy patch tests (APTs) in the diagnostic workup of food allergy. METHODS: We investigated 437 children (median age, 13 months; 90% with atopic dermatitis) referred for evaluation of suspected food allergy. Specific serum IgE (sIgE) measurements, skin prick tests (SPTs), APTs, and controlled oral food challenges were performed. RESULTS: We analyzed 873 oral challenges with cow's milk, hen's egg, wheat, and/or soy. One thousand seven hundred single APTs were performed. As a single parameter, the APTs showed the best specificity compared with sIgE measurements, SPTs, or both. Combining the APT with either the SPT or sIgE measurement resulted in improved sensitivity and specificity. Decision points for sIgE measurement and for the SPT showed lower values when combined with a positive APT result. Correctly bypassing an oral food challenge with combined testing, including APTs, only between 0.5% and 7% (99% predicted probability) and between 6% and 14% (using 95% predicted probability) of children would fulfill the criteria for avoiding an oral food challenge. CONCLUSION: Although the predictive capacity of the APT is improved when combined with sIgE measurement or the SPT, oral food challenges become superfluous in only 0.5% to 14% of study patients. In addition, the APT is time consuming and demands a highly experienced test evaluator. CLINICAL IMPLICATIONS: For daily clinical practice, the APT adds only a small predictive value to the standard SPT and sIgE measurement in the diagnostic workup of suspected food-related symptoms in our study population.

Age Factors↗
PubMed2006

Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxide.

BACKGROUND: Children with severe asthma have persistent symptoms despite treatment with inhaled corticosteroids (ICSs). The differentiating features of severe asthma in children are poorly defined. OBJECTIVE: To identify features of severe versus mild-to-moderate asthma in school-age children using noninvasive assessments of lung function, atopy, and airway inflammation. METHODS: A total of 75 children (median age, 10 years) with asthma underwent baseline characterization including spirometry and lung volume testing, methacholine bronchoprovocation, allergy evaluation, and offline measurement of exhaled nitric oxide (F(ENO)). Twenty-eight were followed longitudinally over 6 months. Participants were assigned to the severe asthma subgroup if they required high-dose ICS plus 2 or more minor criteria. RESULTS: Children with severe versus mild-to-moderate asthma had more symptoms, greater airway obstruction, more gas trapping, and increased bronchial responsiveness to methacholine. Subjects with severe asthma also had higher concentrations of F(ENO) and significantly greater sensitization to aeroallergens. With long-term study, both the reduction in FEV(1) and increase in F(ENO) persisted in the severe versus mild-to-moderate group. Furthermore, despite adjustments in ICS doses, the frequency of exacerbations was significantly higher in subjects with severe (83%) versus mild-to-moderate asthma (43%). CONCLUSION: Severe asthma in childhood is characterized by poor symptom control despite high-dose ICS treatment and can be differentiated from mild-to-moderate asthma by measurement of lung function and F(ENO). CLINICAL IMPLICATIONS: Clinicians should suspect severe asthma in children with poor response to ICS, airway obstruction, and high F(ENO).

Adolescent↗
PubMed2006

Sex-related differences in immune development and the expression of atopy in early childhood.

BACKGROUND: Sex and age are known to influence the clinical expression of asthma and allergic diseases. OBJECTIVE: We sought to evaluate whether immune response profiles also vary by sex and age. METHODS: We performed a prospective birth cohort study (Childhood Origins of Asthma) designed to evaluate interactions among age, sex, immune responses, and virus infections on the development of asthma and allergic diseases. Two hundred eighty-nine subjects were enrolled at birth, and 275 maintained prospective follow-up for 3 years. Cytokine response profiles at birth, 1, and 3 years of age; rates of wheezing, atopic dermatitis, and viral illnesses; and biomarkers of atopy, including total and specific IgE levels and peripheral eosinophil counts, were evaluated. RESULTS: PHA-induced IFN-gamma responses were higher in boys at 1 year of age (median, 35 vs 19 pg/mL; P < .001) and at 3 years of age (median, 282 vs 181 pg/mL; P = .07). Among children who wheezed during the third year of life, boys had increased IFN-gamma, IL-5, and IL-13 responses at age 3 years (P < .001, P = .008, and P = .01, respectively). Boys also demonstrated increased rates of sensitization (P = .05 at year 1), total IgE levels (P = .03 at year 1 and P = .006 at year 3), and peripheral eosinophil counts (2.62 vs 1.85; P = .05 at year 3). CONCLUSION: Sex-specific differences in immune responses develop during early childhood; some of these differences developmentally proceed, whereas others occur in parallel to the clinical expression of various atopic phenotypes. CLINICAL IMPLICATIONS: The differential expression of atopic diseases between boys and girls in early childhood is accompanied by sex-specific differences in immune response profiles.

Cells, Cultured↗
PubMed2006

Interrelationships of quantitative asthma-related phenotypes in the Epidemiological Study on the Genetics and Environment of Asthma, Bronchial Hyperresponsiveness, and Atopy.

BACKGROUND: Delineating asthma subphenotypes is of interest to understand the cause of the disease. Few studies have addressed the interrelationships of quantitative asthma-related traits. OBJECTIVE: We sought to study the interrelationships of allergy markers and FEV(1) in relation to asthma and sex in children and adults. METHODS: Total IgE levels, skin prick test (SPT) positivity, eosinophil counts, and FEV(1) were assessed in 299 asthmatic cases (children and adults) recruited in chest clinics and 309 nonasthmatic population-based control subjects in the French Epidemiological Study on the Genetics and Environment of Asthma, Bronchial Hyperresponsiveness, and Atopy. RESULTS: Allergy parameters were significantly higher in asthmatic cases than in control subjects for children and adults and for both sexes. Sex and age modified the pattern of concordance of high IgE levels, SPT positivity, and eosinophilia among asthmatic cases, with the greatest overlap in male children (64%) and the lowest in male adults (18%). Patterns of change over the lifespan of IgE levels, eosinophil counts, and FEV(1)/height(2) varied, with the acceleration of FEV(1) decrease being particularly evident in asthmatic adults. In adult cases and control subjects, SPT positivity (particularly to indoor allergens) was significantly related to IgE levels but not to eosinophil counts. The association of eosinophil counts with IgE levels was evident only in children. Environmental factors (smoking, pets, and country living) did not alter the patterns observed. CONCLUSIONS: Each allergy-related phenotype showed a distinct relation with asthma, with the role for eosinophils being different than that for IgE levels and SPT responses. CLINICAL IMPLICATIONS: Taking age and sex into account is essential for understanding the interrelationships of the various allergy-related phenotypes to asthma status.

Adult↗
PubMed2004

Low levels of immunoglobulin A in children with intrinsic asthma: a possible protection against atopy.

Immunoglobulin A and G (IgA, IgG) serum concentrations were detected in children with nonallergic/intrinsic (36 children) or allergic/extrinsic asthma (43 children) and in age-matching control children (40 children). Asthmatic children with allergic asthma had lower IgA (1.36+/-0.54 g/L) and higher IgG (10.48+/-2.77 g/L) levels than the age-matching control children group (1.63+/-0.69 vs. 9.01+/-2.32 g/L). Children with nonallergic/intrinsic asthma had lower IgA (1.03+/-0.41 g/L) ( p = 0.004) and IgG (8.38+/-1.93 g/L) (p = 0.001) levels than the allergic/extrinsic asthma group (1.36+/-0.54 vs. 10.48+/-2.77 g/L). Low IgA levels were found in children with nonallergic/intrinsic asthma and high IgG levels were found in those children with allergic/extrinsic childhood asthma. The hypothesis is that the increased incidence of asthma in the population may be caused by a decrease in childhood infections (hygiene hypothesis). Frequent infections in early life boost the immune system, stimulating Th1-type response in young children and reducing the risk of atopic diseases. Our hypothesis is that low IgA (and/or IgG) levels in our patients might be responsible for infection development among those children with nonallergic/intrinsic asthma. These infections stimulate the normal development of immune system in young children, reducing risk of atopy, so that those children do not get allergic/extrinsic childhood asthma. Intrinsic childhood asthma=nonallergic (nonatopic) childhood asthma. Extrinsic childhood asthma=allergic (atopic) childhood asthma.

Adolescent↗
PubMed2005

Phenotypes of asthma revisited upon the presence of atopy.

Immunological studies claimed that atopic and non-atopic asthma share more similarities than differences. However, these two phenotypes of asthma are considered to be distinguishable upon distinct clinical patterns, which were not systematically assessed before in a large population. We studied characteristics discriminating atopic from non-atopic asthma among 751 asthmatic patients and 80 factors were analysed in univariate and multivariate analysis. Age, age of onset of asthma, female/male ratio were higher in non-atopic (n=200) than in atopic (n=551) asthmatics. Familial asthma, seasonal symptoms, rhinitis, conjunctivitis, allergen-triggered symptoms, improvement in altitude, exercise-induced asthma were associated with atopy. Non-atopic asthmatics displayed lower FEV(1) and FVC. Smoking was more frequent and asthma was more severe in these patients. Younger age, early onset, male sex, rhinitis and smoking were independent factors discriminating atopic from non-atopic asthma. This study establishes in a large population of asthmatics that although similarities exist between atopic and non-atopic asthma, two clinical phenotypes can still distinguish both kinds of asthma.

Adolescent↗
PubMed2004

Immunophenotyping of the cutaneous cellular infiltrate after atopy patch testing in cats with atopic dermatitis.

Cats with spontaneously occurring atopic dermatitis have clinical and immunocytochemical characteristics compatible with these in humans with atopic dermatitis (AD). The atopy patch test (APT) has proven to be a valuable tool in elucidating the disease process in humans. Additionally, the APT is very specific and bypasses the problem of conflicting results due to differences in chronicity of lesions of AD patients. We adapted the APT for use in cats to explore the suitability of the APT as a tool to study the onset of allergic inflammation in cats with atopic dermatitis. APT were performed in AD cats (n = 6) and healthy cats (n = 10). All cats were patch tested with two allergens in three different dilutions and a diluent control. The allergens for the APT were selected from positive intradermal test and /or prick test results and consisted of: Dermatophagoides farinae, D. pteronyssinus, Tyrophagus putrescentiae, and a grass pollen mixture. APT were read after 10, 24 and 48 h, and punch biopsies for immunohistochemical evaluation were collected at these time points. Macroscopically positive APT reactions were observed in three out of six cats at 24 and/or 48 h with allergen concentrations of 25,000 and 100,000 NU/ml. Reactions were not observed at negative control sites and neither in control animals. A significantly increased number of IL-4+, CD4+, CD3+, MHC class II+ and CD1a+ cells was found in one AD cat with positive APT reactions. Five out of six AD cats had significantly increased IL-4+ T cell numbers at 24 and/or 48 h. Our data indicate that in cats, macroscopically positive patch test reactions can be induced, which have a cellular infiltrate similar to that in lesional skin. We found a high specificity and a macroscopically positive APT reaction in half of the cats, which is similar to what is seen in humans. Hence, the APT in cats might be a useful tool in studying the immunopathogenesis of feline atopic dermatitis.

Allergens↗
PubMed2002

Association between skin test diagnosed atopy and professionally diagnosed depression: a Northern Finland 1966 Birth Cohort study.

BACKGROUND: Several studies have suggested an association between IgE-mediated atopic allergies and depression, although thus far no epidemiologic evidence involving a large, unselected, general-population sample and valid methods in diagnosing atopy support this putative association. METHODS: We used the Northern Finland 1966 Birth Cohort, which was followed prospectively to age 31. Of the total cohort, 5428 individuals underwent skin tests for three of the most common allergens (i.e., cat, birch, and timothy grass) and for dust mites (Dermatophagoides pteronyssinus). Data on doctor-diagnosed lifetime depression were obtained from questionnaires. RESULTS: After adjusting for social class, mothers' parity, place of residence, and psychiatric morbidity, the logistic regression analysis showed that the risk of developing depression when compared with nonatopic subjects increased up to 1.8-fold in atopic women (adjusted odds ratio 1.8, 95% confidence interval [CI] 1.2-2.6) and, when compared with skin-test-negative female subjects without allergic symptoms, reached 2.7-fold increases (95% CI 1.6-4.6) in those suffering from clinically manifest atopic disorders. Corresponding associations were not found among male subjects. CONCLUSIONS: Our results indicate that women suffering from atopic diseases may possess an elevated risk for developing depression during early adulthood. Possible background theories (i.e., genetic abnormalities in serotonin metabolism, hypothalamic-pituitary-adrenal axis dysfunction, and histamine theory) are discussed.

Adult↗
PubMed2001

Bronchial hyperactivity in bakers and its relation to atopy and skin reactivity.

Data from literature suggests that a significant percentage of bakers develop occupational asthma and chronic obstructive bronchitis, the primary reason for this being the strong allergenic properties of flour. The aim of this study was to evaluate the prevalence of bronchial hyperactivity in bakers, as well as to correlate bronchial hyperactivity with positive skin tests and atopy. A group of 100 bakers (54 males and 46 females) employed in bread production for an average of 14.8 +/- 8.8 years, were examined from 1996 to 1999. Bronchial challenge tests with methacholine (cumulative dose of 4 mg) and flour were performed. It was considered positive if a FEV1 reduction of at least 20% from normal values had occurred. Additionally, skin prick tests were performed with wheat flour extracts, as well as standard environmental inhalation allergens. Total IgE were assessed using the ELISA method. Results showed that 11% of bakers demonstrated a positive methacholine test, 2% of bakers responded to the specific bronchial challenge test with wheat flour. The skin prick test with wheat flour was positive in 15% of bakers, while the same test using standard inhalation allergens was positive in 12% of bakers. Atopic status was found in 18% of bakers. The frequency of positive methacholine test was 33% in bakers with atopic status, compared to 6.1% (P < 0.01) in those without atopic status. Among the bakers who displayed a positive skin test to wheat flour, specific bronchial challenge test with flour was positive in two (13.3%) bakers, while no response to the bronchial challenge test with flour was observed in bakers with negative skin test. This is in agreement with known results.

Adult↗
PubMed2003

Developmental cytokine response profiles and the clinical and immunologic expression of atopy during the first year of life.

BACKGROUND: Allergic diseases have been linked to abnormal patterns of immune development, and this has stimulated efforts to define the precise patterns of cytokine dysregulation that are associated with specific atopic phenotypes. OBJECTIVE: Cytokine-response profiles were prospectively analyzed over the first year of life and compared with the clinical and immunologic expressions of atopy. METHODS: Umbilical cord and 1-year PBMCs were obtained from 285 subjects from allergic families. PHA-stimulated cytokine-response profiles (IL-5, IL-10, IL-13, and IFN-gamma) were compared with blood eosinophil counts and total and specific IgE levels (dust mites, cat, egg, Alternaria species, peanut, milk, and dog) at age 1 year and at the development of atopic dermatitis and food allergy. RESULTS: For the cohort as a whole, cytokine responses did not evolve according to a strict TH1 or TH2 polarization pattern. PHA-stimulated cord blood cells secreted low levels of IL-5 (2.1 pg/mL), moderate levels of IFN-gamma (57.4 pg/mL), and greater amounts of IL-13 (281.8 pg/mL). From birth to 1 year, IL-5 responses dramatically increased, whereas IL-13 and IFN-gamma responses significantly decreased. Reduced cord blood secretion of IL-10 and IFN-gamma was associated with subsequent sensitization to egg. In addition, there was evidence of TH2 polarization (increased IL-5 and IL-13 levels) associated with blood eosinophilia and increased total IgE levels by age 1 year. CONCLUSION: These findings demonstrate that cytokine responses change markedly during the first year of life and provide further evidence of a close relationship between TH2 skewing of immune responses and the incidence of atopic manifestations in children.

Aging↗
PubMed1995

Evaluation of variables influencing the outcome of the atopy patch test.

BACKGROUND: The number of positive atopy patch test (APT) results in patients with atopic eczema (AE) varies in different studies, probably because of different test techniques. Variables that may influence the outcome of the APT were evaluated. METHODS: APTs were performed in 84 patients with AE, 30 control patients with atopic disease, and 85 healthy volunteers, with house dust mite and grass pollen allergens in concentrations of 100, 1000, 10,000, and 100,000 allergenic units/ml. The influence of 0, 10, or 20 tape strippings was investigated. The tests were performed on the back and/or the antecubital fossa and evaluated after 20 minutes and 24, 48, and 72 hours. In all patients the total and specific serum IgE levels were measured. RESULTS: The maximal number of positive APT results were obtained under the following conditions: an allergen concentration equal to 10,000 allergenic units/ml, 10 tape strippings and readings at 24 and 48 hours. Positive APT results were observed in five of 30 control patients with atopic disease and in none of 85 healthy volunteers. Statistically significantly higher total and allergen-specific serum IgE levels were found in the group of patients with AE with positive APT results. CONCLUSIONS: We recommend the previously described conditions to get an optimal method for APT. The correlation between the APT and the total and specific serum IgE suggests an important role for IgE in the reaction mechanism behind the APT.

Adult↗
PubMed1995

Atopy patch test with different vehicles and allergen concentrations: an approach to standardization.

BACKGROUND: In some patients with atopic eczema, eczematous skin lesions can be induced by patch testing with aeroallergens. METHODS: To establish a standardized system for the atopy patch test (APT), 36 patients with atopic eczema, four patients with rhinoconjunctivitis and 10 healthy control subjects were epicutaneously tested with allergen extracts from house dust mite, cat dander, and grass pollen. APTs were performed on nonabraded, uninvolved skin with 1000 and 10,000 protein nitrogen units (PNU)/gm allergen in petrolatum or hydrogel. Reactions were evaluated after 48 and 72 hours and compared with skin prick and specific serum IgE (CAP-RAST; Pharmacia, Uppsala, Sweden). RESULTS: After 48 hours, 57 clear-cut positive reactions with eczematous, often follicle-bound, appearance were diagnosed from a total of 432 test sites. Seventy-two percent of these positive reactions in patients with atopic eczema developed with 10,000 PNU/gm and 28% with 1000 PNU/gm. Sixty-seven percent of reactions were elicited with allergens in petrolatum versus 33% when hydrogel was used as vehicle. Allergen-specific concordances of APT (10,000 PNU/gm, petrolatum) ranged from 0.39 to 0.53 (prick test) and 0.42 to 0.69 (CAP-RAST). In healthy control subjects and patients with rhinoconjunctivitis without atopic eczema, no clear-cut positive APT reaction was seen. CONCLUSIONS: Petrolatum as vehicle and an allergen concentration higher than 1000 PNU/gm may lead to improved APT results on unchanged skin. In the future, the clinical relevance of an IgE-mediated sensitization for eczematous skin lesions may be evaluated by the APT.

Adolescent↗
PubMed1996

Evaluation of the atopy patch test and the cutaneous late-phase reaction as relevant models for the study of allergic inflammation in patients with atopic eczema.

OBJECTIVE: The study was designed to evaluate the atopy patch test (APT) and the late-phase reaction (LPR) after intracutaneous allergen injection as models for the study of allergic inflammation in atopic eczema. METHODS: Immunocytochemistry was used to analyze skin biopsy specimens from sites of APTs and LPRs at 2 and 24 hours and to compare these with lesional and nonlesional skin of patients with atopic eczema. RESULTS: A lack of neutrophil infiltration in specimens from both the APT and lesional skin sites was observed, whereas neutrophils were abundantly present in the specimens from LPR sites. With double-staining techniques it was demonstrated that the few neutrophils present in specimens from APT sites and in lesional skin were mostly located in intravascular areas, whereas in the LPR specimens they were located predominantly in extravascular areas. Eosinophils infiltrated at an earlier time point in the LPR as compared with the APT. Furthermore, there was a decrease of intact mast cells in the LPR site compared with the APT sites and lesional skin. No significant difference in T-cell number was observed between the two tests. Upregulation of E-selectin expression on endothelial cells occurred at an earlier time point in the LPR as compared with the APT. CONCLUSION: There are important differences in cellular infiltrate between the APT and the LPR. The close macroscopic and microscopic similarities between the specimens from APT sites and lesional skin of patients with atopic eczema support the argument that the APT is a more valid in vivo model with which to study allergic inflammation in atopic eczema than the LPR.

Adult↗
PubMed1998

Asthma and increased bronchial responsiveness in elite athletes: atopy and sport event as risk factors.

BACKGROUND: High prevalence of bronchial hyperresponsiveness and asthma has been found in cross-country skiers. There is limited evidence that asthma and bronchial responsiveness would be common also in athletes with summer events. OBJECTIVES: The objective of this study was to investigate occurrence of and risk factors for increased bronchial responsiveness and asthma in elite athletes with summer events and to compare their results with those of control subjects. METHODS: Forty-nine speed and power athletes (mean age 21.1 years, range 16 to 31), 71 long-distance runners (mean age 26.6 years, range 16 to 39), 42 swimmers (mean age 18.6 years, range 14 to 25), and 45 control subjects (mean age 26.7 years, range 21 to 37) were studied. The subjects answered questionnaires and were given a resting spirometric examination, a skin prick test, and a histamine challenge test. RESULTS: Current asthma (current asthmatic symptoms and increased bronchial responsiveness) was observed in 14% (22 of 162) of the athletes and in 2% (1 of 45) of the control subjects (p = 0.041). Total asthma (current asthmatic symptoms and increased bronchial responsiveness or physician-diagnosed asthma) occurred in 23% (37 of 162) of the athletes and in 4% (2 of 45) of the control subjects (p = 0.0048). Atopy according to skin prick test results was found in 48% (77 of 162) of the athletes and in 36% (16 of 45) of the control subjects (not significant). Clinical pollen allergy (positive skin test reaction to pollen and symptoms of rhinoconjunctivitis) was significantly (p = 0.037) more common in athletes than in control subjects. Atopic athletes showed significantly more often increased bronchial responsiveness, current asthma, and total asthma than nonatopic athletes (p = 0.011, p = 0.0049, and p < 0.0001, respectively), and the odds ratios of increased bronchial responsiveness and asthma increased with the number of positive skin test reactions. After adjustment for confounding factors, the odds ratio for the occurrence of current asthma was 5.49 (95% confidence interval 0.56 to 53.7) in speed and power athletes, 2.88 (0.30 to 27.7) in long-distance runners, and 10.8 (1.10 to 106.0) in swimmers compared with control subjects. The adjusted odds ratios for the occurrence of total asthma were 3.56 (0.62 to 20.5) in speed and power athletes, 6.01 (1.19 to 30.2) in long-distance runners, and 5.89 (1.00 to 34.5) in swimmers. CONCLUSIONS: Asthma is more common in highly trained athletes than in control subjects. Asthma is especially common in elite swimmers, but the risk of asthma is increased also in long-distance runners. Increased bronchial responsiveness and asthma are strongly associated with atopic disposition and its severity in elite athletes.

Adolescent↗
PubMed2000

Dietary vitamin E, IgE concentrations, and atopy.

Vitamin E inhibits IgE responses to allergic stimuli in animals. We investigated the relation between dietary vitamin E intake and serum IgE concentrations and atopy, measured as allergen skin sensitisation, in a random sample of 2633 adults. Higher concentrations of vitamin E intake were associated with lower serum IgE concentrations and a lower frequency of allergen sensitisation. These findings may explain the beneficial effect of dietary vitamin E on the incidence of asthma.

Adult↗
PubMed1977

Complexed IgE in atopy.

Evidence of circulating high-molecular-weight forms of IgE was found in 16 patients with hayfever and/or atopic eczema. This finding of what appears to be complexed IgE in the serum of atopic patients may help to elucidate the aetiology of atopy.

Antigen-Antibody Complex↗