Differential Diagnosis for 28-month-old with Elevated IgE and Constipation

• Single most likely diagnosis:
  • Allergic colitis or food allergy: Elevated IgE levels are often associated with allergic reactions, and constipation can be a symptom of an allergic gastrointestinal disorder. The child's age and symptoms make this a plausible diagnosis.
• Other Likely diagnoses:
  • Atopic dermatitis with secondary skin infection or allergy-related constipation: Children with atopic dermatitis often have elevated IgE levels and may experience constipation due to dietary restrictions or secondary infections.
  • Cow's milk protein allergy: This condition can cause elevated IgE levels and gastrointestinal symptoms, including constipation, in infants and young children.
  • Eosinophilic gastrointestinal disorder: Although less common, this condition is characterized by elevated IgE levels and gastrointestinal symptoms, including constipation, due to eosinophilic infiltration of the gut.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Hirschsprung's disease: A congenital condition characterized by the absence of ganglion cells in the colon, leading to severe constipation. Although less likely, it's crucial to rule out this condition due to its potential for severe complications if left untreated.
  • Intestinal obstruction or intussusception: Although rare, these conditions can cause constipation and require immediate medical attention to prevent serious complications.
• Rare diagnoses:
  • Immunodeficiency disorders (e.g., Hyper-IgE syndrome): These conditions are characterized by elevated IgE levels and recurrent infections, but can also present with gastrointestinal symptoms, including constipation.
  • Gastrointestinal mastocytosis: A rare condition characterized by the accumulation of mast cells in the gut, leading to gastrointestinal symptoms, including constipation, and elevated IgE levels.