D3.67 - Retrospective Evaluation of IgE Panel Utility in Allergy Diagnostics: Insights from Baghdad, Iraq

Interpretation of allergy tests is challenging in polysensitized patients, as multiple IgE sensitizations often do not correlate with clinical allergy. We aimed to examine patterns of total and specific IgE results from a case series at a specialized allergy laboratory in Baghdad, highlighting polysensitization, early infant food sensitization, test-symptom mismatches, prevalent allergens and coexisting autoimmune markers.

Retrospective review of 50 patients (children and adults) undergoing routine allergy evaluation over 2 years. Total IgE and specific IgE to common inhalant and food allergens were assessed using an IgE immunoblotting technique; specific IgE levels were categorized (Class 1–3 as low-to-moderate sensitization). Polysensitization was defined as ≥2 positive allergen-specific IgEs. Clinical records were reviewed for any discrepancies between test findings and symptoms (e.g., chronic urticaria with negative IgE). Selected patients were also tested for autoimmune markers (e.g., thyroid autoantibodies). All data were anonymized.

Polysensitization was common (70% of patients had ≥2 allergen-specific IgEs, including 40% with ≥3); most specific IgE results were of low titer (Class 1–3). Among infants (<2 years, n=10), half had early food sensitization (milk or egg, Class 1–2) without any clinical reactions. Test-symptom mismatches occurred in 5 cases (10%); notably, 3 patients with chronic urticaria had negative allergen panels, suggesting non-IgE triggers. Grass pollen was the most common aeroallergen (>50% of patients) and seafood (fish/shellfish) was the most common food allergen (20%, mainly in older patients). Autoimmune markers were positive in 4 patients (8%), mostly in those with chronic urticaria or systemic complaints, suggesting an autoimmune component.

Multiple low-level IgE sensitizations require cautious interpretation, as they often do not result in clinical allergy, especially in infants. Conversely, allergic symptoms despite negative IgE (e.g., chronic urticaria) may indicate non–IgE or autoimmune mechanisms, warranting further evaluation. Recognizing prevalent local allergens (grass pollen, seafood) and checking for autoimmune markers in select cases can help tailor management. These findings provide practical insights to guide care of polysensitized or diagnostically challenging allergy patient