Two patients with extreme elevations in serum IgE were found to have falsely low levels of IgE when measured by a commercial immunoradiometric assay. Dilution studies performed on serum from both patients revealed the rise and subsequent fall of the dose-response curve characteristic of the high-dose "hook" or prozone effect. Specimens with unexpectedly low levels of serum IgE obtained by either commercial immunoradiometric assay or enzyme immunoassay should be reanalyzed after dilution.
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