# Allergic Diseases in Common Variable Immunodeficiency: A Prospective Cross‐Sectional Study on Prevalence and Allergy Biomarkers of Clinical Phenotypes

## TL;DR

This study finds that about 27% of CVID patients have allergic diseases, and low IgE and IgA levels are linked to specific disease phenotypes, aiding diagnosis and prognosis.

## Contribution

The study identifies low IgE and IgA levels as biomarkers for lymphoproliferative and granulomatous phenotypes in CVID patients.

## Key findings

- Allergic diseases were present in 26.6% of CVID patients, primarily allergic rhinitis and bronchial asthma.
- Low IgE and IgA levels were strongly associated with lymphoproliferative and granulomatous CVID phenotypes.
- Combined IgE and IgA assessment improved prognostic stratification with high diagnostic accuracy.

## Abstract

The link between allergic conditions and common variable immunodeficiency (CVID) is still unclear. Only a few studies suggest allergic diseases are more prevalent in CVID patients than in the general population, and the role of IgE remains poorly defined. This study aims to evaluate the prevalence of allergic conditions in CVID and the role of serum IgE and IgA levels. This prospective, cross‐sectional, case–control study enrolled Italian adult CVID patients to investigate allergic conditions' frequency and relationships between IgE, IgA, and clinical phenotypes. Analyses of diagnostic/prognostic accuracy were performed with ROC curves. We documented an allergic disease in 26.6% of 60 CVID patients, most commonly allergic rhinitis (56.2%) and bronchial asthma (12.5%). CVID patients with allergy had higher IgE levels (+8.9 kU/L, p = 0.006) than non‐allergic ones, but lower than allergic individuals without CVID. IgE deficiency was observed in 65% of CVID patients, with a strong correlation between IgE and IgA levels (r = 0.7, p < 0.001). Low IgE (< 2.5 kU/L) and IgA levels (< 7 mg/dL) were significantly associated with lymphoproliferative (p < 0.001) and granulomatous phenotypes (p = 0.005), achieving an AUC of 94% and 81% for predicting lymphoproliferation and granulomatosis, respectively. The prevalence of allergic conditions in CVID patients is lower compared with previous studies. Low IgE levels served as a good biomarker for CVID and CVID‐phenotypes. Combined serum IgE and IgA assessment improved prognostic stratification.

Allergy occurred in 27% of 60 CVID patients, while IgE deficiency was observed in 65% and was strongly correlated with serum IgA levels. Low serum IgE/IgA levels accurately identified lymphoproliferative and granulomatous phenotypes, thereby improving diagnostic and prognostic stratification in CVID.