Skip to Content

Hyper-IgE Syndrome

(Hyperimmunoglobulinemia E Syndrome; Buckley Syndrome)

By

James Fernandez

, MD, PhD, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University

Last full review/revision Dec 2019| Content last modified Dec 2019

Hyper-IgE (hyperimmunoglobulinemia E) syndrome is a hereditary immunodeficiency disorder characterized by recurring boils, sinus and lung infections, and a severe rash that appear during infancy. Levels of immunoglobulin E (IgE) are very high.

  • In infants with hyper-IgE syndrome, abscesses form in the skin, joints, lungs, or other organs.
  • Blood tests can confirm the diagnosis.
  • Treatment involves giving antibiotics to prevent or treat infections, creams or drugs to relieve the rash, and drugs that modify the immune system.

(See also Overview of Immunodeficiency Disorders.)

Hyper-IgE syndrome is a primary immunodeficiency disorder. It may be inherited in one of two ways:

  • As an autosomal (not sex-linked) dominant disorder: That is, only one gene for the disorder, one from either parent, is required.
  • As an autosomal recessive disorder: That is, two genes for the disorder, one from each parent, are required.

How hyper-IgE is inherited depends on which gene is affected. Why levels of IgE are high is unknown. Both forms cause similar symptoms.

Symptoms

Symptoms of hyper-IgE syndrome usually begin during infancy. In most infants, pockets of pus (abscesses) form in the skin, joints, lungs, or other organs. The abscesses are usually caused by infections with staphylococcal bacteria, and they recur frequently.

People may develop respiratory infections, including pneumonia that may leave giant cysts after the pneumonia has resolved.

An itchy rash develops.

Bones are weak, resulting in many fractures. Facial features may be coarse. Loss of baby teeth is delayed.

Life span depends on the severity of the lung infections.

Diagnosis

  • Blood tests to measure IgE levels
  • Sometimes genetic testing

Hyper-IgE syndrome is suspected when boils and pneumonia develop frequently in infants. The diagnosis is confirmed by blood tests that detect a high level of IgE.

Genetic tests can be done to check for the abnormal genes.

Treatment

  • Antibiotics

Antibiotics, usually trimethoprim/sulfamethoxazole, are given continuously to prevent staphylococcal infections.

The rash is treated with moisturizing creams, antihistamines, and, if infection is likely, antibiotics. Respiratory infections are treated with antibiotics.

Certain drugs that modify the immune system, such as interferon gamma, are sometimes helpful.

More Information

  • Immune Deficiency Foundation

Drugs Mentioned In This Article

Generic Name Select Brand Names
trimethoprim No US brand name

Copyright © 2021 Merck & Co., Inc., known as MSD outside of the US, Kenilworth, New Jersey, USA. All rights reserved. Merck Manual Disclaimer