ANA Testing in Relation to Lupus and Allergies

Q: ANA Testing in Relation to Lupus and Allergies

Hello, thank you for your question. <br>Here are my responses： <br>1. <br>Although the ANA test result is negative, considering that the butterfly rash appeared in September, which was four months ago, how accurate is this blood test? Can systemic lupus erythematosus (SLE) have a

Regarding ANA testing in systemic lupus erythematosus?

Hello, around September 2022, I experienced redness and itching on my face and scalp, along with peeling skin and increased hair loss.
I also felt fatigued and had difficulty concentrating.
However, I did not have joint pain or fever.
There were areas of redness, itching, and peeling on my face resembling a butterfly rash.
Initially, I thought it was an allergy, but after visiting a dermatologist, I was diagnosed with seborrheic dermatitis.
The doctor prescribed a topical steroid, which improved my condition after a week, but once I stopped the medication, the rash reappeared.
It spread to my cheeks, appearing faintly red, without swelling, just redness and itching.
Feeling quite anxious, I went to a major hospital for blood tests, where the doctor checked my ANA and immunoglobulin levels.
The results were: ANA: Negative.
IgE: 547, which is significantly elevated.
Since I have a history of allergies, I understand that IgE levels can be high.
I have a few questions for the doctor: 1.
Although my ANA is negative, it has been four months since the butterfly rash appeared in September.
Is this blood test still accurate? Can systemic lupus erythematosus (SLE) show a negative ANA during a remission period? Or is it always positive regardless of remission or active phase, with only variations in the levels? Does my negative result essentially rule out the possibility of SLE, or should I get tested again? 2.
Is there a connection between elevated IgE levels and lupus erythematosus? Thank you, doctor, for your response.

KH, 40~49 year old female. Ask Date: 2023/01/26

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
Although the ANA test result is negative, considering that the butterfly rash appeared in September, which was four months ago, how accurate is this blood test? Can systemic lupus erythematosus (SLE) have a negative ANA during a remission phase? Or is it that ANA will always be positive regardless of whether it is a remission or active phase, just with varying levels? Does a negative result essentially rule out the possibility of SLE, or should I get a second test? --> The accuracy of a negative ANA result is high, and the timing of the ANA test is not related to whether the patient is in an active phase.
However, there are rare exceptions.
ANA is not the sole diagnostic criterion for lupus, so if you continue to have skin symptoms and are concerned, it is advisable to discuss with your physician the possibility of retesting ANA or other related tests after three months to six months.
2.
Is a high IgE level related to lupus? --> It should not be related.
IgE is not a diagnostic criterion for systemic lupus erythematosus.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/01/26

More Info

Understanding ANA Testing in Relation to Lupus and Allergies
Thank you for sharing your medical history and concerns regarding your symptoms and the results of your recent ANA (Antinuclear Antibody) test. It’s important to clarify the implications of these test results, especially in the context of lupus and allergies.

1. ANA Testing and Lupus: The ANA test is a screening tool used to detect autoimmune disorders, including systemic lupus erythematosus (SLE), commonly known as lupus. A negative ANA result, as you received, generally suggests that lupus is less likely. However, it is crucial to understand that the ANA test is not definitive. Some individuals with lupus can have a negative ANA, particularly during periods of remission or when the disease is not active.
The presence of symptoms such as the butterfly rash, fatigue, and hair loss can be indicative of lupus, but they can also be associated with other conditions, including allergic reactions or skin disorders like seborrheic dermatitis, which you mentioned was diagnosed by your dermatologist. The fact that your ANA was negative suggests that it is less likely you have lupus, but it does not completely rule it out, especially if your symptoms persist or worsen.
It is also worth noting that ANA levels can fluctuate based on disease activity. In some cases, patients may test negative during remission and positive during flare-ups. Therefore, if your symptoms continue or if new symptoms arise, it may be prudent to repeat the ANA test or conduct further testing, such as anti-dsDNA or anti-Smith antibodies, which are more specific for lupus.

2. High IgE Levels and Lupus: Elevated IgE levels are typically associated with allergic responses and conditions such as asthma, eczema, and allergic rhinitis. While lupus can have various manifestations, high IgE levels are not directly linked to lupus itself. However, individuals with autoimmune conditions can also have allergic tendencies. Your high IgE level indicates an allergic response, which could explain some of your symptoms, such as the itchy, red rash on your face.

In summary, while your negative ANA result is reassuring and suggests a lower likelihood of lupus, it is not conclusive. The symptoms you are experiencing could be due to an allergic reaction or another dermatological condition. If your symptoms persist or worsen, consider following up with your healthcare provider for further evaluation. They may recommend additional tests or referrals to specialists, such as a rheumatologist or an allergist, to explore your symptoms more thoroughly.

In the meantime, managing your allergies and any skin conditions with appropriate treatments, such as topical corticosteroids for inflammation, may help alleviate your symptoms. Always consult your healthcare provider before making any changes to your treatment plan. Thank you for your questions, and I hope this information helps clarify your concerns!

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