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Test ID: HIESG Hyper-IgE Syndrome Gene Panel, Varies


Ordering Guidance


Targeted testing for familial variants (also called site-specific or known variants testing) is available for the genes on this panel. See FMTT / Familial Variant, Targeted Testing, Varies. To obtain more information about testing option, call 800-533-1710.



Shipping Instructions


Specimen preferred to arrive within 96 hours of collection.



Specimen Required


Patient Preparation: A previous bone marrow transplant from an allogenic donor will interfere with testing. Call 800-533-1710 for instructions for testing patients who have received a bone marrow transplant.

 

Submit only 1 of the following specimens:

 

Specimen Type: Whole blood

Container/Tube:

Preferred: Lavender top (EDTA) or yellow top (ACD)

Acceptable: Any anticoagulant

Specimen Volume: 3 mL

Collection Instructions:

1. Invert several times to mix blood.

2. Send whole blood specimen in original tube. Do not aliquot.

Specimen Stability Information: Ambient (preferred)4 days/Refrigerated

 

Specimen Type: Skin biopsy

Supplies: Fibroblast Biopsy Transport Media (T115)

Container/Tube: Sterile container with any standard cell culture media (eg, minimal essential media, RPMI 1640). The solution should be supplemented with 1% penicillin and streptomycin.

Specimen Volume: 4-mm punch

Specimen Stability Information: Refrigerated (preferred)/Ambient

Additional Information: A separate culture charge will be assessed under CULFB / Fibroblast Culture for Biochemical or Molecular Testing. An additional 3 to 4 weeks is required to culture fibroblasts before genetic testing can occur.

 

Specimen Type: Cultured fibroblasts

Container/Tube: T-25 flask

Specimen Volume: 2 Flasks

Collection Instructions: Submit confluent cultured fibroblast cells from a skin biopsy from another laboratory. Cultured cells from a prenatal specimen will not be accepted.

Specimen Stability Information: Ambient (preferred)/Refrigerated (<24 hours)

Additional Information: A separate culture charge will be assessed under CULFB / Fibroblast Culture for Biochemical or Molecular Testing, Tissue. An additional 3 to 4 weeks is required to culture fibroblasts before genetic testing can occur.


Forms

1. New York Clients-Informed consent is required. Document on the request form or electronic order that a copy is on file. The following documents are available:

-Informed Consent for Genetic Testing (T576)

-Informed Consent for Genetic Testing (Spanish) (T826)

2. Molecular Genetics: Congenital Inherited Diseases Patient Information (T521)

3. Inborn Errors of Immunity, Autoimmunity, and Autoinflammatory Disease Patient Information

Useful For

Providing a comprehensive genetic evaluation for patients with a personal or family history suggestive of hyper-IgE syndrome (HIES)

 

Establishing a diagnosis of HIES, allowing for appropriate management and surveillance for disease features based on the gene and/or variant involved

 

Identifying variants within genes known to be associated with HIES, allowing for predictive testing of at-risk family members and/or determination of targeted management (anticipatory guidance, management changes, specific therapies)

Genetics Test Information

This test utilizes next-generation sequencing to detect single nucleotide and copy number variants in 21 genes associated with hyper-IgE syndrome: AIRE, CARD11, CARD9, CARMIL2, DOCK8, ERBIN, IL6R, IL6ST, IL17RA, IL17RC, IL17F, PGM3, SPINK5, STAT1, STAT3, TGFBR1, TGFBR2, TRAF3IP2, TYK2, WAS, and ZNF341. See Targeted Genes and Methodology Details for Hyper-IgE Syndrome Gene Panel and Method Description for additional details.

 

Identification of a disease-causing variant may assist with diagnosis, prognosis, clinical management, recurrence risk assessment, familial screening, and genetic counseling for hyper-IgE syndrome.

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
CULFB Fibroblast Culture for Genetic Test Yes No

Testing Algorithm

For skin biopsy or cultured fibroblast specimens, fibroblast culture will be performed at an additional charge. If viable cells are not obtained, the client will be notified.

Method Name

Sequence Capture and Targeted Next-Generation Sequencing (NGS)

Reporting Name

Hyper-IgE Syndrome Gene Panel

Specimen Type

Varies

Specimen Minimum Volume

Blood: 1 mL; Skin biopsy or cultured fibroblasts: See Specimen Required

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Varies

Clinical Information

Hyper IgE syndrome (HIES) is characterized by an increased susceptibility to infection (particularly recurrent skin and pulmonary infections), eczema, and elevated serum IgE. There is variable expression among individuals and additional features may be present, including vascular, skeletal, and connective tissue pathology. While the incidence of HIES is estimated to be between 1:100,000 to 1,000,000 at birth, this may be an underestimate due to incomplete penetrance.

 

Dominant negative variants in STAT3 were first identified as the genetic cause of HIES, which was referred to as Job syndrome. Now additional genes have been identified, and cases due to STAT3 variants are referred to as STAT3-HIES. Infection in STAT3-HIES is often due to Staphylococcus aureus and Candida species. While HIES may be inherited in an autosomal dominant pattern, many cases are de novo.

 

Genetic variants in additional genes have been identified that result in HIES. ZNF341 (zinc finger protein 341) deficiency results in an autosomal recessive form of HIES, also known as AR-HIES. Partial deficiency of interleukin (IL) 6 signal transducer (IL6ST) has been reported in both autosomal recessive and autosomal dominant forms of HIES, while complete IL6ST deficiency is typically fatal in utero or early in the neonatal period. Additionally, variants in PGM3, CARD11, and other genes have been identified as causes of HIES. Furthermore, other distinct immunodeficiency disorders or other conditions may have overlapping features with HIES (eg, elevated IgE or severe infection), making the diagnosis challenging. While the phenotypes of disorders leading to elevated IgE and predisposition to infection are often similar, the therapeutic options and treatment strategies differ.

Reference Values

An interpretive report will be provided

Interpretation

All detected variants are evaluated according to American College of Medical Genetics and Genomics (ACMG) recommendations.(1) Variants are classified based on known, predicted, or possible pathogenicity and reported with interpretive comments detailing their potential or known significance.

Clinical Reference

1. Richards S, Aziz N, Bale S, et al; ACMG Laboratory Quality Assurance Committee: Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med. 2015 May;17(5):405-424

2. Tsilifis C, Freeman AF, Gennery AR: STAT3 Hyper-IgE syndrome-an update and unanswered questions. J Clin Immunol. 2021 Jul;41(5):864-880

3. Asano T, Khourieh J, Zhang P, et al: Human STAT3 variants underlie autosomal dominant hyper-IgE syndrome by negative dominance. J Exp Med. 2021 Aug 2;218(8):e20202592. doi: 10.1084/jem.20202592

4. Hsu AP, Davis J, Puck JM, Holland SM, Freeman AF: STAT3 hyper IgE syndrome. In: Adam MP, Everman DB, Mirzaa GM, et al, eds. GeneReviews.[Internet] University of Washington, Seattle; 2010. Updated March 26, 2020. Accessed January 23, 2023. Available at www.ncbi.nlm.nih.gov/books/NBK25507/

5. Tangye SG, Al-Herz W, Bousfiha A, et al: Human inborn errors of immunity: 2022 update on the classification from the International Union of Immunological Societies Expert Committee. J Clin Immunol. 2022 Oct;42(7):1473-1507. doi: 10.1007/s10875-022-01289-3

Day(s) Performed

Varies

Report Available

28 to 42 days

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

81443

88233- Tissue culture, skin, solid tissue biopsy (if appropriate)

88240- Cryopreservation (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HIESG Hyper-IgE Syndrome Gene Panel 103740-7

 

Result ID Test Result Name Result LOINC Value
619817 Test Description 62364-5
619818 Specimen 31208-2
619819 Source 31208-2
619820 Result Summary 50397-9
619821 Result 82939-0
619822 Interpretation 69047-9
619823 Additional Results 82939-0
619824 Resources 99622-3
619825 Additional Information 48767-8
619826 Method 85069-3
619827 Genes Analyzed 82939-0
619828 Disclaimer 62364-5
619829 Released By 18771-6
Mayo Clinic Laboratories | Genetics and Genomics Additional Information:

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