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Atopic Eczema — SCE Dermatology MCQ

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ModerateInflammatory DermatosesAtopic EczemaSCE Dermatology

A 28-year-old woman with severe atopic eczema has a raised total serum IgE of 5200 kU/L. She asks whether this high IgE means she has allergic disease causing her eczema. What is the correct interpretation?

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Correct answer: A — Elevated IgE is a non-specific finding in atopic eczema and does not confirm specific allergen-driven disease

Total serum IgE is elevated in approximately 80% of atopic eczema patients but is a non-specific marker of atopic tendency. It does not identify specific allergen triggers or predict treatment response. Very high total IgE can occur in severe eczema without specific allergen-driven disease. Specific IgE testing (or skin prick tests) should only be performed when there is clinical suspicion of specific allergen triggering (immediate reactions to specific exposures) — not as routine screening. Up to 20% of atopic eczema patients have normal IgE ('intrinsic' atopic eczema). Total IgE should not be used to guide elimination diets.

Reference: NICE 2007 CG57; BAD AD Guidelines; EAACI 2020