Dear Parent,
Thank you for your query at DoctorSpring.com
I understand your concerns. These are significant indeed.
The fact that your child has HYPER-EOSINOPHILIA (22% Eosinophil count ) is something significant. Associated with elevated IgE levels, it is even more important not to ignore the findings.
Does your son have any symptoms other than his eczema?
What is his height and weight? How is his school performance ?
Does he have any history of worms in stools?
In which area do you reside? Is it a filarial endemic zone?
Is there any family history of recurrent infections/ unexplained deaths?
HyperIgE syndrome is a rare immunodeficiency disorder that classically presents with elevated IgE levels, eosinophilia and eczema/allergic/dermatitis. Your child seems to have all three. So first and foremost, we need to rule out this serious condition. It is very rare, yet I reiterate that this condition may present subtly and needs to be suspected.
Does your child have any of the following?
- Recurrent skin boils/ pyoderma/ skin infections
- Any past history of pneumonia/ serious infection
- History of delayed falling off of primary teeth
- Characteristic facial feature: The characteristic facial features are usually set by age 16. These include facial asymmetry, a prominent forehead, deep-set eyes, a broad nasal bridge and a wide, fleshy nasal tip. Additionally, facial skin may be rough with prominent pores
Presence of one or more features listed above, could be a clue to underlying HyperIgE or Jobs syndrome.
Apart from the above condition, numerous parasitic infections can have increased eosinophils and IgE levels. It is important to get tested for microfilariae, trichuris, visceral larva migrants, ancyclostoma, Wuchereria, etc.. Stool testing as well as serological testing may be useful. If detected, use of appropriate anthelminthic/ anti-parasitic agents can be curative.
Treatment for the above condition with Montair-LC (Montelukast), a leukotriene inhibitor does not appear to entirely justified. The cause of underlying problem needs to be investigated and appropriate treatment given.
Regards
Dr. Saptharishi L G
Dr. Saptharishi L G