Skip to main content

Advertisement

Log in

Clinical Manifestation of Hyper IgE Syndrome Including Otitis Media

  • Otitis (DP Skoner, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The hyper IgE syndromes (HIES) comprise a group of rare primary immunodeficiency disorders (PIDDs), which are characterized by extremely high serum IgE levels, eczema, recurrent skin and pulmonary infections. Both autosomal dominant (AD) HIES due to STAT3 mutations and autosomal recessive (AR) HIES due to PGM3, SPINK5, DOCK8 and TKY2 mutations have been reported. Here, we aim to summarize and compare the major clinical manifestations of different subtypes of HIES. We will also discuss otitis media, which usually do not get enough attention in HIES. Update and familiarity with these clinical features will help to make a better diagnose, assessment and treatment of HIES.

Recent Findings

Although hyper serum IgE levels have been identified in PGM3 deficiency and Comel–Netherton syndrome, PGM3 and SPINK5 genes were not included in the list of genetic etiologies of AR-HIES by the Expert Committee of the International Union of Immunological Societies until 2015. The identification of these HIES-causing genes greatly promoted the pathogenic mechanism studies of HIES. Also, in recent years, more clinical manifestations, which were often not of concern in HIES patients, have been shown to be highly related to HIES. For example, a significantly high frequency of vascular and gastrointestinal abnormities has been reported in STAT3-deficient AD-HIES patients. These new findings might help to provide new clues to the functional study of these HIES-related genes.

Summary

This review summarizes and compares the major clinical manifestations of different subtypes of HIES, and we suggest that the incidence and severity of otitis media should not be underestimated in HIES patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hashemi H, Mohebbi M, Mehravaran S, Mazloumi M, Jahanbaniardakani H, Abtahi SH. Hyperimmunoglobulin E syndrome: genetics, immunopathogenesis, clinical findings, and treatment modalities. J Res Med Sci. 2017;22(1):53.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Davis SD, Schaller SJ, Wedgwood RJ. Job’s Syndrome : recurrent, "cold", staphylococcal abscesses. Lancet. 1966;287(7445):1013–5.

    Article  Google Scholar 

  3. Buckley R. Extreme hyperimmunoglobulinemia E and undue susceptibility to infection. Pediatrics. 1972;49(1):59–70.

    PubMed  CAS  Google Scholar 

  4. Wu J, Chen J, Tian ZQ, Zhang H, Gong RL, Chen TX, et al. Clinical manifestations and genetic analysis of 17 patients with autosomal dominant Hyper-IgE Syndrome in Mainland China: new reports and a literature review. J Clin Immunol. 2017;37(2):166–79.

    Article  PubMed  CAS  Google Scholar 

  5. Minegishi Y, Saito M, Morio T, Watanabe K, Agematsu K, Tsuchiya S, et al. Human tyrosine kinase 2 deficiency reveals its requisite roles in multiple cytokine signals involved in innate and acquired immunity. Immunity. 2006;25(5):745–55.

    Article  PubMed  CAS  Google Scholar 

  6. Minegishi Y, Saito M, Tsuchiya S, Tsuge I, Takada H, Hara T, et al. Dominant-negative mutations in the DNA-binding domain of STAT3 cause hyper-IgE syndrome. Nature. 2007;448(7157):1058.

    Article  PubMed  CAS  Google Scholar 

  7. Engelhardt KR, Mcghee S, Winkler S, Sassi A, Woellner C, Lopez-Herrera G, et al. Large deletions and point mutations involving the dedicator of cytokinesis 8 (DOCK8) in the autosomal-recessive form of hyper-IgE syndrome. J Allergy Clin Immunol. 2009;124(6):1289–302.e4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. •• Picard C, Bobby GH, Alherz W, Bousfiha A, Casanova JL, Chatila T, et al. International Union of Immunological Societies: 2017 Primary Immunodeficiency Diseases Committee Report on Inborn Errors of Immunity. J Clin Immunol. 2018;38(1):96–128. COMMENT: This report details the categorization and listing of 354 inborn errors of immunity.

    Article  PubMed  Google Scholar 

  9. Gernez Y, Tsuang A, Smith TD, Shahjehan K, Hui Y, Maglione PJ, et al. Hemoptysis in a patient with elevated immunoglobulin E. J Allergy Clin Immunol Pract. 2016;4(6):1054–8. https://doi.org/10.1016/j.jaip.2016.08.003.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Eberting CL, Davis J, Puck JM, Holland SM, Turner ML. Dermatitis and the newborn rash of hyper-IgE syndrome.Digest of the World Core Medical Journals. Arch Dermatol. 2005;140(9):1119–25.

  11. Minegishi Y, Saito M. Cutaneous manifestations of Hyper IgE syndrome. Allergol Int. 2012;61(2):191–6. https://doi.org/10.2332/allergolint.12-RAI-0423.

    Article  PubMed  CAS  Google Scholar 

  12. Schimke LF, Sawallebelohradsky J, Roesler J, Wollenberg A, Rack A, Borte M, et al. Diagnostic approach to the hyper-IgE syndromes: immunologic and clinical key findings to differentiate hyper-IgE syndromes from atopic dermatitis. J Allergy Clin Immunol. 2010;126(3):611–7.e1.

    Article  PubMed  CAS  Google Scholar 

  13. Minegishi Y, Saito M. Cutaneous manifestations of Hyper IgE Syndrome. Allergol Int. 2002;141(4):572–5.

    Google Scholar 

  14. Erlewyn-Lajeunesse MDS. Hyperimmunoglobulin-E syndrome with recurrent infection: a review of current opinion and treatment. Pediatr Allergy Immunol. 2010;11(3):133–41.

    Article  Google Scholar 

  15. • Pichard DC, Freeman AF, Cowen EW. Primary immunodeficiency update: Part I. Syndromes associated with eczematous dermatitis. J Am Acad Dermatol. 2015;73(3):365–6. COMMENT: Discusses clinical manifestations of HIES caused by STAT3, DOCK8 and PGM3, especially eczematous dermatitis.

    Article  Google Scholar 

  16. Lehman H. Skin manifestations of primary immune deficiency. Clin Rev Allergy Immunol. 2014;46(2):112–9. https://doi.org/10.1007/s12016-013-8377-8.

    Article  PubMed  CAS  Google Scholar 

  17. Chandesris MO, Melki I, Natividad A, Puel A, Fieschi C, Yun L, et al. Autosomal dominant STAT3 deficiency and Hyper-IgE Syndrome molecular, cellular, and clinical features from a French National Survey. Medicine. 2012;91(4):1–19.

    Article  CAS  Google Scholar 

  18. Chu EY, Freeman AF, Jing H, Cowen EW, Davis J, Su HC, et al. Cutaneous manifestations of DOCK8 deficiency syndrome. Arch Dermatol. 2012;148(1):79–84.

    Article  PubMed  CAS  Google Scholar 

  19. Yong PF, Freeman AF, Engelhardt KR, Holland S, Puck JM, Grimbacher B. An update on the hyper-IgE syndromes. Arthritis Res Ther. 2012;14(6):228.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sarri CA, Roussakischulze A, Vasilopoulos Y, Zafiriou E, Patsatsi A, Stamatis C, et al. Netherton syndrome: a genotype-phenotype review. Mol Diagn Ther. 2016;21(2):1–16.

    Google Scholar 

  21. Mogensen TH. Primary immunodeficiencies with elevated IgE. Int Rev Immunol. 2015;35(1):39–56.

    PubMed  Google Scholar 

  22. Yang L, Fliegauf M, Grimbacher B. Hyper-IgE syndromes: reviewing PGM3 deficiency. Curr Opin Pediatr. 2014;26(6):697–703.

    Article  PubMed  CAS  Google Scholar 

  23. Engelhardt KR, Gertz ME, Keles S, Schäffer AA, Sigmund EC, Glocker C, et al. The extended clinical phenotype of 64 patients with dedicator of cytokinesis 8 deficiency. J Allergy Clin Immunol. 2015;136(2):402–12.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Urschel S. Otitis media in children with congenital immunodeficiencies. Curr Allergy Asthma Rep. 2010;10(6):425.

    Article  PubMed  Google Scholar 

  25. Wilson NW, Hogan MB. Otitis media as a presenting complaint in childhood immunodeficiency diseases. Curr Allergy Asthma Rep. 2008;8(6):519–24.

    Article  PubMed  Google Scholar 

  26. • Costa-Carvalho BT, Grumach AS, Franco JL, Espinosa-Rosales FJ, Leiva LE, King A, et al. Attending to warning signs of primary immunodeficiency diseases across the range of clinical practice. J Clin Immunol. 2014;34(1):10–22. COMMENT: Summarizes the warning signs of PIDDs, including otitis media.

    Article  PubMed  Google Scholar 

  27. Fleisher TA. Autosomal recessive phosphoglucomutase 3 (PGM3) mutations link glycosylation defects to atopy, immune deficiency, autoimmunity, and neurocognitive impairment. J Allergy Clin Immunol. 2014;133(5):1400–9.e5.

    Article  CAS  Google Scholar 

  28. Stray-Pedersen A, Backe P, Sorte H, Mørkrid L, Chokshi N, Erichsen HC, et al. PGM3 mutations cause a congenital disorder of glycosylation with severe immunodeficiency and skeletal dysplasia. Am J Hum Genet. 2014;95(1):96–107.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Su HC. Dedicator of cytokinesis 8 (DOCK8) deficiency. Curr Opin Allergy Clin Immunol. 2010;10(6):515–20.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Chen XF, Wang WF, Zhang YD, Zhao W, Wu J, Chen TX. Clinical characteristics and genetic profiles of 174 patients with X-linked agammaglobulinemia: report from Shanghai, China (2000–2015). Medicine. 2016;95(32):e4544.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Urschel S, Kayikci L, Wintergerst U, Notheis G, Jansson A, Belohradsky BH. Common variable immunodeficiency disorders in children: delayed diagnosis despite typical clinical presentation. J Pediatr. 2009;154(6):888–94.

    Article  PubMed  Google Scholar 

  32. Arora M, Bagi P, Strongin A, Heimall J, Zhao X, Lawrence MG, et al. Gastrointestinal manifestations of STAT3-deficient hyper-IgE syndrome. J Clin Immunol. 2017;37(7):1–6.

    Article  CAS  Google Scholar 

  33. Kilic SS, Hacimustafaoglu M, Boissondupuis S, Kreins AY, Grant AV, Abel L, et al. A patient with tyrosine kinase 2 deficiency without hyper-IgE syndrome. J Pediatr. 2012;160(6):1055–7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Freeman AF, Holland SM. Clinical manifestations of hyper IgE syndromes. Dis Markers. 2010;29(3-4):123.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sowerwine KJ, Holland SM, Freeman AF. Hyper-IgE syndrome update. Ann N Y Acad Sci. 2012;1250(1):25–32.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Sanal O, Jing H, Ozgur T, Ayvaz D, Straussalbee DM, Ersoyevans S, et al. Additional diverse findings expand the clinical presentation of DOCK8 deficiency. J Clin Immunol. 2012;32(4):698–708.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Yavuz H, Chee R. A review on the vascular features of the hyperimmunoglobulin E syndrome. Clin Exp Immunol. 2010;159(3):238–44.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Chandesris MO, Azarine A, Ong KT, Taleb S, Boutouyrie P, Mousseaux E, et al. Frequent and widespread vascular abnormalities in human STAT3 deficiency. Artery Res. 2011;5(4):163.

    Article  Google Scholar 

  39. Szczawinskapoplonyk A, Kycler Z, Pietrucha B, Heropolitanskapliszka E, Breborowicz A, Gerreth K. The hyperimmunoglobulin E syndrome - clinical manifestation diversity in primary immune deficiency. Orphanet J Rare Dis. 2011;6(1):1–11.

    Article  Google Scholar 

  40. Farmand S, Sundin M. Hyper-IgE syndromes: recent advances in pathogenesis, diagnostics and clinical care. Curr Opin Hematol. 2015;22(1):12–22.

    Article  PubMed  CAS  Google Scholar 

  41. Aydin SE, Kilic SS, Aytekin C, Kumar A, Porras O, Kainulainen L, et al. DOCK8 deficiency: clinical and immunological phenotype and treatment options - a review of 136 patients. J Clin Immunol. 2015;35(2):189.

    Article  PubMed  CAS  Google Scholar 

  42. Sun JD, Linden KG. Netherton syndrome: a case report and review of the literature. Digest of the World Core Medical Journals. Int J Dermatol. 2010;45(6):693–7.

Download references

Grant numbers

This research was supported by grants from National Natural Science Foundation of China (81571605 and 81701626).

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Li Hong or Tong-Xin Chen.

Ethics declarations

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Otitis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, J., Hong, L. & Chen, TX. Clinical Manifestation of Hyper IgE Syndrome Including Otitis Media. Curr Allergy Asthma Rep 18, 51 (2018). https://doi.org/10.1007/s11882-018-0806-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11882-018-0806-6

Keywords

Navigation