Q: My daughter (1 year and 7 months old) is falling sick frequently. What we usually see is breathing disorder, cough, nose blockage & mild to high fever etc. We tried a couple of doctors including homeopathy. With due respect to all doctors, their prescription worked well but only as a temporary fix. This time the doctor suggested blood serum IgE examination and we were surprised to find that it is 203% or ml when the normal range was told to us as 2% - 50%. A parallel blood report says RBC & haemoglobin are less than normal range. My wife and I are patients of bronchitis and eosinophilia and believe this could a reason for the child's health. The new allopath told us that we should not take our child to open places having wind flows, crowded market places, cinema halls etc. We would appreciate if you can explain in detail what the the IgE test indicates and how do we cope with the problem?

A:Your daughter is most probably suffering from allergic rhinitis, one of the most common chronic diseases in children. The elevated IgE level also supports the diagnosis. IgE is an immunoglobulin produced by the B-lymphocytes and present in serum in small amounts, but is the principal mediator of hypersensitivity reactions. Elevated IgE levels suggests the presence of an allergic disorder. Elevated IGE can also be seen in a number of other disorders like atopic dermatitis, helminthic infections, to name a few. Specific allergen responsible for the disease can be identified by skin tests or in vitro serum testing (RAST). The facilities are available in most metros and tertiary care centers. The treatment of the disease is based on the severity, impact of disease in patient and the expected capacity of the patient to comply with the instructions of the treating physician (you are already complaining about the lifestyle changes!). It involves environmental control, use of antihistamines such as loratdine, cetirizine or fexofenadine (which are non sedating and generally given once or twice a day) and topical decongestants. Nasal steroid preparations which have no systemic effects are now preferred by most specialists and are very effective during an acute episode. Immunotherapy (subcutaneous administration of increasing doses of allergen if a specific allergen can be identified) is last resort if all other measures fail. Prevention is possible in some cases with preparations like cromolyn sodium (nasal) and montelucast (oral), but rarely used in very young children. Relapses are the rule even with the best treatment. The disease tend to become less severe as the age advances. I note that your daughter is more than 1 year and 7 months according to the date of birth. There is no known association with ghee and oil rich food with this disease. Allergies are known to run in families, but allergic rhinitis and eosiniophilia are not related. The child has anaemia according to the blood tests and the most likely cause is nutritional iron deficiency.