Helminthic therapy and immunoglobulin E (IgE)

Helminth infections are universally associated with responses characterised by Th2 cytokines, high levels of IgE, eosinophilia and mastocytosis.

The immune response to helminth infections has long been known to share key features with the allergic response. In particular, both are typified by enhanced T helper 2 (Th2) responses with high levels of interleukin-4 (IL-4), IL-5 and IL-13, accompanied by eosinophilia and abundant IgE production. [1]

Eosinophilia, mastocytosis, and IgE stimulation are the three main immune alterations observed during a hookworm infection in humans… During hookworm infection, serum levels of IgE increase 100-fold. [2]

Serum IgE levels were high in a Papua New Guinean population infested with hookworm. Serum IgE and blood eosinophil levels fell after treatment with anthelmintics. [3]

Individuals who maintain a hookworm colony for therapeutic purposes will typically see an increase in IgE following inoculation, but these levels should decrease over time. One doctor who practises functional medicine has reported observing the reduction of an IgE level of 1,000 in a highly allergic patient, to normal, in just a few weeks following the introduction of helminths.

Doctor's Farmacy with Mark Hyman, M.D., Episode 13 (Watch from 54.00 minutes.)

When one individual expressed concern that his IgE antibodies are always elevated above normal levels, even when compared to the time before he hosted hookworms, and that this persistent elevation might be permanent, a medical doctor with a special interest in helminthic therapy - who also hosts helminths himself - responded with this:

To my knowledge, infections do not produce a permanent increase in immunoglobulin levels. The immune system is fluid and is constantly inhibiting and producing different classes of antibodies and T cells depending on what pathogens are being detected by circulating APCs, free IgM and T-cells. IgE antibody production by B-cells will taper off once the inciting agent is cleared, however a more swift and vigorous response to the inciting organism will result next time it is introduced. This is a result of memory cells keeping a record of whats been seen and explains why HW rashes get worse over time. It would not make any sense that this would make a disease state worse however; there is no logical explanation I can see in there for that. Just as the therapeutic benefit goes away, so does the increased antibody and eosinophil production.

William Parker, formerly Associate Professor of Surgery at Duke University, has opined that what we consider to be 'normal' in terms of the immune system may be anything but normal.

A medical doctor has commented thus:

… it is probably normal to have an elevated IgE. The 'normal' values were undoubtedly found by measuring abnormal people! That is, people who lack normal exposure to helminths. [4]

And a team of researchers looking to improve the diagnosis of helminth infections in travelers and migrants returning to Germany from the tropics concluded that, while eosinophil counts are clearly associated with helminthic infections, total IgE was not helpful in differentiating helminth infections from other causes of eosinophilia in this group. [5]

See also