Differential Diagnosis for a 28-month-old with IgE 195

• Single most likely diagnosis:
  • Allergic rhinitis: Elevated IgE levels are commonly seen in allergic reactions, and allergic rhinitis is a prevalent condition in children that can cause elevated IgE levels.
• Other Likely diagnoses:
  • Atopic dermatitis (eczema): This condition is associated with elevated IgE levels and is common in young children.
  • Asthma: Although asthma is more commonly associated with symptoms like wheezing and coughing, elevated IgE can be seen in some cases, especially if there's an allergic component.
  • Food allergy: Certain food allergies can cause an increase in IgE levels, and given the age of the child, common culprits might include peanuts, tree nuts, fish, shellfish, milk, eggs, wheat, and soy.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Hyper-IgE syndrome (Job syndrome): A rare condition characterized by recurrent cutaneous and pulmonary infections and extremely elevated IgE levels. Although rare, it's crucial to consider due to its severe implications.
  • Parasitic infections: Certain parasitic infections, such as hookworm or roundworm infections, can cause elevated IgE levels. Missing these diagnoses could lead to significant morbidity.
• Rare diagnoses:
  • Wiskott-Aldrich syndrome: A rare genetic disorder that affects males and is characterized by eczema, thrombocytopenia, and recurrent infections, with elevated IgE levels being a common finding.
  • Immunodeficiency with elevated IgE: Certain immunodeficiencies can present with elevated IgE levels, and while rare, they are important to consider in the differential diagnosis to ensure appropriate management and treatment.