Journal of Patient Safety & Quality Improvement

Journal of Patient Safety & Quality Improvement

The Correlation of Allergic Sensitization (IgE and Eosinophil Count) with Wheezy Chest in School-Aged Children and Adolescents in Sulaimani City

Document Type : Original Article

Authors
Pishdar Abdullah Ismael 1
Aso Faeq Salih 2
Kamaran Karadakhy 3
1 Clinical Science Branch, College of Medicine, University of Al Sulaimani, Kurdistan region, Iraq.
2 Professor of Pediatric Cardiology, Clinical Science Branch , College of Medicine, University of Al Sulaimani, Kurdistan region.
3 Consultant Pulmonologist & Consultant Internist, Clinical Science Branch , College of Medicine, University of Sulaimani, Kurdistan region of Iraq.
10.22038/psj.2025.91885.1498
Abstract
Introduction:
Wheezing in children is a common symptom of respiratory disorders and is associated with allergic sensitization. This study aimed to evaluate the relationship between biomarkers of allergic sensitization (serum Immunoglobulin E (IgE) and peripheral eosinophil count) and the severity of wheezing symptoms among school-aged children and adolescents in Sulaimani City.
 Materials and Methods:
A cross-sectional study was conducted from January to June 2025 at two major pediatric respiratory centers. Ninety-five children aged 6–18 years with documented wheeze were recruited consecutively. Demographics, clinical history, environmental exposures, and spirometry data were collected. Serum IgE levels and eosinophil counts were measured.  Continuous variables were reported as mean ± standard deviation, while categorical variables were presented as frequencies and percentages Spirometry results, both pre- and post-bronchodilator, were categorized into severe, moderate, or mild obstruction based on FEV1 values.
Results:
The mean age of the subjects was 9.6 years, with 71.6% being male. In a study of 66 children with asthma, pre- and post-bronchodilator spirometry revealed a reduction in the proportion of children with severe persistent asthma after bronchodilator use (from 25.8% to underwent 13.3%). Among the 30 children post-bronchodilator testing, 64.3% showed a positive response (≥12% increase in FEV1), indicating reversible airway obstruction. These results highlight the effectiveness of bronchodilators in improving pulmonary function in children with asthma.
Conclusion:
Higher IgE and eosinophil levels strongly correlate with wheezing severity. Including these biomarkers in routine assessment is advisable, especially where environmental or family atopic risk is high.
Keywords
Absolute eosinophil count
Allergy
Asthma
IgE immunoglobulin
Subjects
  1. Pramod SN. Immunological Basis for the Development of Allergic Diseases-Prevalence, Diagnosis and Treatment Strategies. In: Singh B, editor. Cell Interaction - Molecular and Immunological Basis for Disease Management. Rijeka: IntechOpen; 2021.
  2. Al-Shamrani A, Bagais K, Alenazi A, Alqwaiee M, Al-Harbi AS. Wheezing in children: Approaches to diagnosis and management. International journal of pediatrics & adolescent medicine. 2019;6(2):68-73.
  3. Iqbal SM. Managing wheeze in preschool children: How difficult can it be? Sudanese journal of paediatrics. 2012;12(2):17-26.
  4. Bloom C, Franklin C, Bush A, Saglani S, Quint J. Burden of preschool wheeze and progression to asthma in the UK: Population-based cohort 2007 to 2017. Journal of Allergy and Clinical Immunology. 2021;147(5):1-11.
  5. Hesse L, Oude Elberink JNG, van Oosterhout AJM, Nawijn MC. Allergen immunotherapy for allergic airway diseases: Use lessons from the past to design a brighter future. Pharmacology & Therapeutics. 2022;237:108115. 6. Akar-Ghibril N, Casale T, Custovic A, Phipatanakul W. Allergic Endotypes and Phenotypes of Asthma. The journal of allergy and clinical immunology In practice. 2020;8(2):429-40.
  6. Ogulur I, Mitamura Y, Yazici D, Pat Y, Ardicli S, Li M, et al. Type 2 immunity in allergic diseases. Cellular & Molecular Immunology. 2025; 22(3): 211-42.
  7. Kim YS, Kim HY, Ahn H-S, Sohn TS, Song JY, Lee YB, et al. The association between tobacco smoke and serum immunoglobulin E levels in Korean adults. Internal Medicine. 2017; 56(19): 2571-7.
  8. Naclerio R, Ansotegui IJ, Bousquet J, Canonica GW, D'Amato G, Rosario N, et al. International expert consensus on the management of allergic rhinitis (AR) aggravated by air pollutants: Impact of air pollution on patients with AR: Current knowledge and future strategies. World Allergy Organization Journal. 2020;13(3):100106.
  9. Lu C, Liu Q, Qiao Z, Yang X, Baghani AN, Wang F. High humidity and NO2 co-exposure exacerbates allergic asthma by increasing oxidative stress, inflammatory and TRP protein expressions in lung tissue. Environmental Pollution. 2024;353:124127.
  10. Omima Mohammed OMA, Majeed Mohamed Salih OA, Omer IIA, Mohammed YIA, Mohammed OA, Elgadi A, et al. Frequency of Severe Asthma and Its Clinical Phenotypes at the Asthma Clinic in One of the Largest Sudanese Tertiary Pediatric Hospitals: A Cross-Sectional Hospital-Outpatient-Based Study. Journal of asthma and allergy. 2024;17:693-702.
  11. Wang J, Zhou Y, Zhang H, Hu L, Liu J, Wang L, et al. Pathogenesis of allergic diseases and implications for therapeutic interventions. Signal Transduction and Targeted Therapy. 2023; 8(1): 138.
  12. Doss AM, Stokes JR. Viral infections and wheezing in preschool children. Immunology and Allergy Clinics of North America. 2022; 42(4): 727-41.
  13. Zhuang SJ, Fan TT, Ruan XY, Lai RL, Yan WJ, Liu CY, et al. [A clinical analysis on the distribution characteristics of dermatophagoides pteronyssinus allergen components among children with allergic rhinitis and asthma in a hospital of pediatric in Shenzhen City from 2021 to 2024]. Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. 2024; 58(12): 1885-93.
  14. Rajvanshi N, Kumar P, Goyal JP. Global Initiative for Asthma Guidelines 2024: An Update. Indian pediatrics. 2024;61(8):781-6.
  15. NIH. National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC) 2025 [Available from:
  16. Hon K, Ng DK, Chiu W, Leung AK, Chen D, Leung W. Adapting selected international paediatric asthma guidelines for use in Hong Kong. Hong Kong medical journal= Xianggang yi xue za zhi. 2025;31(2):148-53.
  17. Venkatesan P. 2025 GINA report for asthma. The Lancet Respiratory Medicine. 2025; 13(8): e41-e2.
  18. Chipps BE, Murphy KR, Oppenheimer J. 2020 NAEPP Guidelines Update and GINA 2021-Asthma Care Differences, Overlap, and Challenges. The journal of allergy and clinical immunology In practice. 2022;10(1s):S19-s30.
  19. Shen H, Zhao P, Shang L, Kuai S. The association of peripheral blood inflammatory markers with the distribution patterns of IgE in children with allergen sensitization. BMC immunology. 2025;26(1):75.
  20. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. American journal of respiratory and critical care medicine. 2019;200(8):e70-e88.
  21. Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. The European respiratory journal. 2012;40(6):1324-43.
  22. Cirino E. FEV1 and COPD: How to Interpret Your Results 2025 [Available from:
  23. Louis R, Bougard N, Guissard F, Paulus V, Henket M, Schleich F. Bronchodilation Test with Inhaled Salbutamol Versus Bronchial Methacholine Challenge to Make an Asthma Diagnosis: Do They Provide the Same Information? The Journal of Allergy and Clinical Immunology: In Practice. 2019;8(1):1-11.
  24. Akinbami LJ, Simon AE, Rossen LM. Changing Trends in Asthma Prevalence Among Children. Pediatrics. 2016;137(1):1-7.
  25. Hameed RM, Ahmed MM, Abood HAAN, Hussein AM. To Evaluate Total Serum Immunoglobulin E Level and Factors That Effect on This Level in Iraqi Asthmatic Children. Biomedical and Biotechnology Research Journal (BBRJ). 2019;3(4):240-4.
  26. Rezwan T, Perez M, Jacobs S, Shafik J, Mitchell WB, Conrad LA, et al. Correlation between total IgE level and asthma symptom severity in hospitalized children. J Allergy Clin Immunol Glob. 2025;4(2):100452.
  27. Bleecker ER, Meyers DA, Billheimer D, Li H, Newbold P, Kwiatek J, et al. Clinical Implications of Longitudinal Blood Eosinophil Counts in Patients With Severe Asthma. The Journal of Allergy and Clinical Immunology: In Practice. 2023;11(6):1805-13.
  28. Ebrahimi M, Ghelichi Ghojogh M, Ghezeljeh E, Shirzaeinezhad S, Aghapour SA. Frequency distribution of neutrophil and eosinophil count in children with asthmatic attack referring to Taleghani hospital in Gorgan in 2016-2020. Journal of Preventive Epidemiology. 2023;8(1):1.
  29. Fayezi A, Torabizadeh M, Masoom N, Abolnezhadian F, Ali Samir M, Mirkarimi M, et al. Blood eosinophil count and bronchodilator responsiveness in pediatric patients admitted for wheezing attacks. Immunopathologia Persa. 2021;1(1):1.
  30. Coverstone AM, Bacharier LB, Wilson BS, Fitzpatrick AM, Teague WG, Phipatanakul W, et al. Clinical significance of the bronchodilator response in children with severe asthma. Pediatr Pulmonol. 2019;54(11):1694-703.
  31. Rutting S, Thamrin C, Cross TJ, King GG, Tonga KO. Fixed Airflow Obstruction in Asthma: A Problem of the Whole Lung Not of Just the Airways. Frontiers in Physiology. 2022;13(1):1.
  32. Taherian MR, Fatemian F, Halimi A, Soleimani Y, Jorjani G, Nozari P, et al. Prevalence of asthma among children and adolescents in WHO's Eastern Mediterranean Region: a meta-analysis of over 0.5 million participants. BMC Public Health. 2024;24(1):2148.
  33. Wang J, Cortes-Ramirez J, Gan T, Davies JM, Hu W. Effects of climate and environmental factors on childhood and adolescent asthma: A systematic review based on spatial and temporal analysis evidence. Science of The Total Environment. 2024;951:175863.
  34. Labyad M, Draiss G, El Fakiri K, Ouzennou N, Bouskraoui M. Control of Asthma and its Influencing Factors in Children Followed in Pneumo-pediatrics Consultation at the Mother-child Hospital in the City of Marrakech, Morocco. Open Respir Med J. 2025;19:e18743064340759.
  35. Pattemore PK, Silvers KM, Frampton CM, Wickens K, Ingham T, Fishwick D, et al. Hair nicotine at 15 months old, tobacco exposure and wheeze or asthma from 15 months to 6 years old. Pediatr Pulmonol. 2018;53(4):443-51.
  36. Roff AJ, Robinson JL, Hammond SJ, Bednarz J, Tai A, Clifton VL, et al. Maternal asthma during pregnancy and risks of allergy and asthma in progeny: A systematic review and meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology. 2025;132(8):1045-55.
  37. Korevaar DA, Damen JA, Heus P, Moen MJ, Spijker R, van Veen IH, et al. Effectiveness of FeNO-guided treatment in adult asthma patients: A systematic review and meta-analysis. Clin Exp Allergy. 2023;53(8):798-808.
  38. Bentouhami H, Bungwa MK, Casas L, Coenen S, Weyler J. Asthma occurrence in children and early life systemic antibiotic use: an incidence density study. Allergy, Asthma & Clinical Immunology. 2023;19(1):18.
  39. Padró-Casas C, Basagaña M, Martínez-Colls MdM, García-Olivé I, Pollan Guisasola C, Teniente-Serra A, et al. Prognostic Factors in Severe Eosinophilic Asthma in a Pediatric Population: A Prospective Cohort Study in Spain. J Clin Med. 2024;13(23):7202.
  40. Ortega H, Llanos J-P, Lafeuille M-H, Duh M, Germain G, Lejeune D, et al. Effects of Systemic Corticosteroids on Blood Eosinophil Counts in Asthma: Real-World Data. Journal of Asthma. 2018;56(8):1-26.

 

 

 
Journal of Patient Safety & Quality Improvement
Volume 14, Issue 1
Winter 2026
Pages 59-70