Seasonal allergies and serial changes of serum levels of IgG4 in cases treated with maintenance therapy for IgG4 related disease
(Ant o 1) Ambrosia artemisiifolia (Amb a 1) Artemisia vulgaris (Art v 1) Leucanthemum vulgare (Leu v 1) and perennial allergens of Dermatophagoides pteronyssinus (Der p 1/Der p 2) Canis familiaris (Can f 1) Felis domesticus (Fel d 1) Candida albicans (Can a 1) Aspergillus fumigatus (Asp f 1) and Penicillium citrinum (Pen c 3) The levels of serum IgG4 were measured by nephelometry; levels of IgE were measured by fl uorescence enzyme immunoassay; and levels of allergen specifi c IgE were measured by radio immunosorbent test. Serial changes of IgG4 and IgE were defi ned as fl uctuations of over 20% from the mean concentration across all visits. Specifi c IgE concentrations of 0.70 UA/mL were defi ned as positive reactions for the allergens. Seven (11.3% of the 62 cases exhibited positive response for seasonal allergens only. These positive responses consisted of four cases harboring IgE for B. verrucosa (Bet v 1) and three harboring IgE for D. glomerata (Dac g 1) In Northern Japan (the location of this study) B. verrucosa pollen is released in May, while D. glomerata pollen is released between June and July. They showed clinical symptoms, including rhinorrhea and rhinostenosis in these seasons, but they were not prescribed with both anti allergy medication and glucocorticoid. The levels of serum IgG4 in all of these cases were elevated in the respective seasons (Figure 1) Two of them showed IgE for several seasonal allergens, but it was considered that there was less eff ect on this analysis because the titers of IgE for Bet v 1 were signifi cantly higher than those of the other allergens. On the other hand, twenty fi ve (40.3% of the 62 cases exhibited serial changes of IgG4 levels. The fl uctuation ranges were larger in proportion to the levels of serum IgG4 at the time of diagnosis. There were, of course, no relapsed cases. 25 cases with allergies to perennial allergens or without allergies did not show these serial changes. With regard to IgE, most cases (with or without allergies) exhibited less changes in IgE levels or discrepancy between the peak of IgE levels and the allergens scattering period. This study revealed that serum IgG4 levels also correlated with seasonal allergies in subset of cases with IgG4 RD. Mod Rheumatol, 2015; Early Online: 1 2 (c) 2015 Japan College of Rheumatology DOI: 10.3109/14397595.2014.995893
Modern rheumatology