https://orcid.org/0000-0002-2736-3341
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Rebecca S Treger, Commentary on An Unexpectedly High IgE Level during Allergic Exploration, Clinical Chemistry, Volume 71, Issue 2, February 2025, Pages 246–247, https://doi.org/10.1093/clinchem/hvae176
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IgE myeloma accounts for less than 0.1% of all myeloma diagnoses, and few cases of IgE monoclonal gammopathy of undetermined significance (MGUS) have been published (1). However, IgE heavy chain is not routinely assayed by serum protein electrophoresis and immunofixation, and the true prevalence of IgE MGUS is likely much higher than reported in the literature.
Here, Feugray et al. present a challenging case of an individual with hemoptysis whose workup for allergic bronchopulmonary aspergillosis revealed extremely elevated total IgE. Subsequent investigations identified serum protein electrophoresis and bone marrow findings consistent with biclonal IgE lambda and IgG lambda MGUS.
This case illustrates several important points to help improve detection of IgE MGUS. Firstly, extremely high levels of IgE (>500 000 kU/mL) can be observed in both IgE myeloma and IgE MGUS (1). Immunoassays that quantify total IgE are susceptible to the prozone phenomenon, and significant sample dilution may be required to obtain accurate IgE quantitation.
