{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T14:11:29Z","timestamp":1778163089718,"version":"3.51.4"},"reference-count":16,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: We aimed to evaluate the etiologic distribution of markedly elevated IgE (\u22652000 IU\/mL) and the association of parasitic infections with longitudinal IgE dynamics and National Institutes of Health Hyper-IgE Syndrome (NIH-HIES) score trajectories in pediatric patients. Methods: We retrospectively enrolled 127 pediatric patients with IgE \u22652000 IU\/mL and \u22651 year of longitudinal follow-up at a tertiary allergy clinic (2019\u20132024). The primary outcome was the IgE reduction percentage difference between parasitic and non-parasitic groups. Results: Atopic sensitization was identified in 81.0% of tested patients; genetic evaluation was performed in 40 patients (31.5%), with confirmed IEI in one patient (0.8% of the cohort; 2.5% of those evaluated). Parasitic infections were present in 24.4% of patients (n = 31; intestinal parasites 15.7%, scabies 8.7%, hydatid cyst 1.6%; two patients had concurrent intestinal parasitosis and scabies). Median IgE reduction was 63.8% vs. 27.0% in parasitic versus non-parasitic groups (p &lt; 0.001), persisting after multivariable adjustment (p &lt; 0.001). Parasitic infection independently predicted IgE normalization below 2000 IU\/mL (OR = 8.26; 95% CI: 2.76\u201324.68; p &lt; 0.001). All three NIH-HIES inflammatory components (IgE, eosinophilia, eczema) regressed more often in the parasitic group (all p \u2264 0.01); no patient reached the \u226540-point HIES threshold. Conclusions: Parasitic infections produce a clinical phenotype overlapping with hyper-IgE syndrome, constituting a reversible phenocopy of primary immune dysregulation. In populations with substantial parasitic prevalence, parasitological evaluation may be a useful consideration in children with markedly elevated IgE and indeterminate clinical scores; however, this approach should complement rather than replace comprehensive clinical assessment.<\/jats:p>","DOI":"10.3390\/children13050653","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:15:07Z","timestamp":1778156107000},"page":"653","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Parasitic Infections as Reversible Hyper-IgE Phenocopies in Children with Markedly Elevated IgE: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0741-6749","authenticated-orcid":false,"given":"Kaz\u0131m Okan","family":"Dolu","sequence":"first","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, Kanuni Sultan S\u00fcleyman Training and Research Hospital, Istanbul 34303, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0330-1146","authenticated-orcid":false,"given":"\u0130dan F\u0131rat","family":"Unay","sequence":"additional","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, Kanuni Sultan S\u00fcleyman Training and Research Hospital, Istanbul 34303, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5799-7759","authenticated-orcid":false,"given":"Yasemin","family":"Tepe","sequence":"additional","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, Kanuni Sultan S\u00fcleyman Training and Research Hospital, Istanbul 34303, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4722-1145","authenticated-orcid":false,"given":"Hande \u00dc\u00e7ler","family":"\u00c7\u0131nar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, Kanuni Sultan S\u00fcleyman Training and Research Hospital, Istanbul 34303, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c7a\u011fla","family":"Karavaizo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, Health Sciences University, Ba\u015fak\u015fehir Cam and Sakura City Hospital, Istanbul 34480, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7266-5445","authenticated-orcid":false,"given":"Himmet Haluk","family":"Akar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, Kanuni Sultan S\u00fcleyman Training and Research Hospital, Istanbul 34303, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"207","DOI":"10.21911\/aai.296","article-title":"Differential diagnosis of patients with total serum immunoglobulin E above 2000 IU\/L","volume":"21","author":"Metbulut","year":"2023","journal-title":"Asthma Allergy Immunol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2500\/aap.2009.30.3193","article-title":"Elevated serum immunoglobulin E (IgE): When to suspect hyper-IgE syndrome\u2014A 10-year pediatric tertiary care center experience","volume":"30","author":"Joshi","year":"2009","journal-title":"Allergy Asthma Proc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.anai.2022.07.013","article-title":"Inborn errors of immunity associated with elevated immunoglobulin E","volume":"129","author":"Khan","year":"2022","journal-title":"Ann. 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