Abstract – Objective: The goal of this study was to evaluate the impact of urinary leukotriene E4 (ULTE4) in asthmatic children during acute asthma exacerbation. Also, we wanted to correlate it with the total serum (TS) immunoglobulin (Ig) E level in relation to asthma severity. Methods: This prospective study was conducted in the emergency room of the Department of Pediatrics, Benha University Hospital in Benha, Egypt, from November 2011 to May 2012. In this study, 63 children with acute asthma exacerbation (group I) and 25 healthy children as the control (group II) were included. Their ages ranged between 3–14 years. All children were subjected to a full medical history, and an emphasis was placed on the symptoms of asthma exacerbation and a complete clinical examination. TS IgE and ULTE4 were measured by an enzyme-linked immunosorbent assay after receiving the parents’ consent. The LTE4 concentration was measured in urine samples obtained at the onset of admission and adjusted by urinary creatinine concentrations. Results: The ULTE4 levels were significantly higher in cases compared to the controls (309.7±97.1 versus 14.5±5.7 pg/mg creatinine, respectively). It correlated positively to both the TS IgE and asthma severity in the cases. Also, the TS IgE levels increased significantly in cases (392.1±309.7 IU/mL), when compared to the controls (45.5±22.1 IU/mL). Conclusion: The ULTE4 and the TS IgE levels are significantly elevated during acute asthma episodes in children. The significant positive correlation between the severity of these attacks and the ULTE4 levels makes it a good noninvasive marker for monitoring acute asthma exacerbations and follow-up of the inflammatory process in asthmatic children.