Is serum total IgE levels a good predictor of allergies in children?

OBJECTIVE: To study the role of Serum Total IgE levels as a marker of allergy and to see its association with different host and environmental factors, its association with different systemic allergies and with the increased allergic systemic involvement. METHODS: A cross sectional comparative study was conducted at Liaquat National Hospital Paediatric Medicine Unit and Outpatient Clinic, from December 2007 to October 2008. Two hundred and fifty eight children in the age group 6 months to 12 years meeting the inclusion criteria, were enrolled for the study. Complete blood count and serum total IgE levels were done in all patients. Data was collected and tabulated. Chi-square was applied to test the association of serum Total IgE levels with different variables using SPSS and p-value of <0.05 was taken as statistically significant. RESULTS: Out of 258 patients 166(64.37%) had raised serum total IgE levels (108 males and 92 females). Among host factors there was no significant association of serum total IgE levels with age, sex, height of the patient, positive family history of allergy or age at which symptoms developed (p =or> 0.05), though the correlation of serum total IgE levels was seen with weight of the patient (p < 0.049), early weaning (p < 0.01) and bottle feeding (p < 0.01) in children. Among environmental factors serum total IgE levels had a strong association with exposure to passive smoking (p < 0.01), pollen (p < 0.01), cold (p < 0.01), and pets (p < 0.01). Blood eosinophilia was another factor that had positive association with allergy and raised serum total IgE levels (p < 0.01). However association of serum IgE levels was not statistically significant for any systemic allergies, skin allergy (0.608), food allergy (p < 0.210), allergic sinusitis (p < 0.113), allergic rhinitis (p < 0.358), allergic conjunctivitis (p < 0.507) except for bronchial asthma (p =or<0.01) where serum total IgE levels was also associated with severity of bronchial asthma (p < 0.01). Interestingly there was no significant relationship of increased number of systemic allergies with serum IgE levels. CONCLUSION: Serum total IgE level is a good predictor of allergy in children. It is influenced by early weaning, early bottle feeding, exposure to passive smoking, pollen, cold, and pets and is associated with blood eosinophilia. Also serum total IgE level is a strong predictor of allergy in asthmatic children.

Prevalence of selected disorders of inborn errors of metabolism in suspected cases at a tertiary care hospital in Karachi.

OBJECTIVE: To study the prevalence of selected disorders of inborn errors of metabolism at a tertiary care hospital in Karachi by performing selective screening of high risk clinically suspected individuals. METHODS: Cross sectional comparative study, was done at the Paediatric Endocrine Unit 2 of National Institute of Child Health Karachi in collaboration with Sapporo City Institute of Public Health, Japan. Sixty-two children age < 1 month-10 years meeting the inclusion criteria (Undiagnosed family history of similar illness or deaths, history of recurrent episodes of severe or persistent vomiting for which no infection or surgical cause was found and history of undiagnosed neurological symptoms and developmental delay) were enrolled in the study. Routine workup of inborn errors of metabolism was done in each child and their dried blood samples (DBS) and dried urine samples (DUS) were send to IEM Selective Screening Unit Japan. SPSS version 10 was used to derive results and p-value of < 0.05 was taken as statistically significant. RESULTS: Out of 62 children, sixteen children (9 boys and 7 girls) were positive for inborn errors of metabolism (IEM). Respiratory distress (p = 0.042) and developmental delay (p = 0.048) were found to be the most common clinical presentations in our children. Out of 16 children with positive results, 14 children had history of death of siblings with similar complaints (p = 0.027). Consanguineous marriage was reported in 13 children. Among children with positive results 10 (62.5%) had organic acidemias, 1 (6.2%) had Ornithine Transcarbamylase (OTC) deficiency (Urea cycle defect) and 5 (31.2%) had congenital lactic acidemias. CONCLUSION: Significant number of positive cases were seen in our series of patients, establishing the fact that IEM is prevalent in our population, though undiagnosed. Further such studies are needed on our side in future to determine incidence of metabolic disorders in Pakistan, which can be achieved by developing local facilities, neonatal screening programmes and collaboration with other countries who are actively working in this field.