3.5 Altered serum Sphingosine 1-phosphate (S1P); ceramide-1-phosphate (CIP) and serum IgE in VKC
In order to check, changes in the systemic level, the metabolites namely S1P and C1P were estimated by ELISA. The serum C1P level was lowered in the total VKC group compared to the control (p<0.05) and this was seen in both R-VKC and NR-VKC (Figure 4A) . Serum SIP was significantly higher in the non-refractory VKC compared to control (p<0.05), while R-VKC had levels similar to control(Figure 4B) .
IgE levels were significantly increased in VKC (P=0.0007) and this was observed both in NR-VKC (p=0.013) and in R-VKC (p=0.004) with no difference amongst the two (Figure 4C) . The quantitative estimation revealed a mean of 1433 ± 2061 ng/mL in control (median = 504 ng/mL), while VKC group revealed a mean of 3801±3719 ng/mL (median = 3719 ng/mL) with > 95 % case showing IgE levels more than the median of the control.