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ALLERGY with elevated IGE, EOSINOPHILS and WBC count.

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my son 7.5 years old seems to have allergies for the past 3 years...only few back we realized that he has elevated IgE levels (1700+) and 22% eosinophils count, wbc 10.6*.....his spirometer test was normal....he has never had severe attacks. we have been giving montrar lc kid for a month and also bonacide forte for 12 days. after a month eosinophils count became 13%, we didnt check IgE levels, wbc count 10.9*

Doc says the eosinophils count is a significatn reduction and will gradually reduce, we havent check IgE, will IgE levels also would have come down? And why is the small increase in WBC count inspite of significat reduction in eosinophils.

Category: Pediatrician

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Category: ICU/ Critical Care Specialist
 31 Doctors Online

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


Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
Dr. Saptharishi L G and 4 other Medical Specialists are ready to help you

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