The patient is a 14-year-old Canadian girl born to non-consanguineous parents (Figure 1A) who presented with microcephaly, mild intellectual disability, severe and broad food allergies (Table 1), atopic dermatitis, asthma, elevated IgE (Figure 1B), eosinophilia (Figure 1C), alopecia totalis, brittle nails, prurigo nodularis, and antinuclear antibodies. Here, IGHE is linked to prurigo nodularis.