Saturday, July 31, 2010
Peripheral eosinophilia often accompanies allergic rhinitis, asthma, eosinophilic esophagitis and atopic dermatitis. I usually accept values up to 3.0 x 109/L of blood (normal being less than 0.4 - 0.6 depending on the lab) as being a related phenomenon. At values up to this level I’d make sure I had good control of the underlying condition. High levels of peripheral eosinophils are seen in Churg-Strauss vasculitis, a condition often associated with asthma. An eosinophil count rising above 3.0 is frequently seen in Churg-Strauss vasculitis and the p-ANCA often becomes positive.
Systemic steroids should be initiated to bring the eosinophil count down. At values over 1.5 x 109/L, when there’s no obvious underlying condition, consider hypereosinophilic syndrome, drug reactions, a parasitic infection or, rarely, an underlying malignancy. High levels of peripheral eosinophils can also occur in primary eosinophilia without any of the aforementioned conditions and this can be difficult to treat. Refer these patients to an allergist/clinical immunologist or hematologist.
Hematologist response:
There’s no such thing as a normal person with eosinophilia. Eosinophilia is abnormal. There are many conditions that are associated with this ailment. Eosinophilia associated with atopy or atopic dermatitis is generally not identified with other systemic or organ abnormalities. It may be associated with gastrointestinal disease: eosinophilic esophagitis, eosinophilic gastroenteritis and eosinophilic colitis.
Eosinophilia may be related to pulmonary infiltration: Loeffler’s syndrome, allergic angiitis and granulomatosis (Churg-Strauss syndrome), hypersensitivity vasculitis and allergic bronchopulmonary aspergillosis. This abnormality may be associated with neoplastic or myeloproliferative disorders: hypereosinophilic syndrome (HES), eosinophilic leukemia, lymphoma, bronchogenic carcinoma and many metastatic malignancies.
Patients with HES have persistent eosinophil count of 1.5 x 109/L for more than 6 months and generally have evidence of multiple organ involvement, especially cardiac dysfunction and central nervous system damage. It’s not the eosinophilia that requires referral for investigation, but rather the presence of associated conditions that determine the need for referral. If the problems are related to the gastrointestinal system, refer the patient to a gastroenterologist. When they’re associated with pulmonary abnormalities that you can’t identify, consult a respirologist and if there are additional hematological abnormalities, refer to a hematologist.
When to worry about eosinophilia
December 2008
At what level of eosinophilia should we worry and what’s the best investigation — in a “normal” person and in a patient with atopy? When do we refer? ANTHONY CZAHARYN, MD, Kirkland, QC
Allergist response:Peripheral eosinophilia often accompanies allergic rhinitis, asthma, eosinophilic esophagitis and atopic dermatitis. I usually accept values up to 3.0 x 109/L of blood (normal being less than 0.4 - 0.6 depending on the lab) as being a related phenomenon. At values up to this level I’d make sure I had good control of the underlying condition. High levels of peripheral eosinophils are seen in Churg-Strauss vasculitis, a condition often associated with asthma. An eosinophil count rising above 3.0 is frequently seen in Churg-Strauss vasculitis and the p-ANCA often becomes positive.
Systemic steroids should be initiated to bring the eosinophil count down. At values over 1.5 x 109/L, when there’s no obvious underlying condition, consider hypereosinophilic syndrome, drug reactions, a parasitic infection or, rarely, an underlying malignancy. High levels of peripheral eosinophils can also occur in primary eosinophilia without any of the aforementioned conditions and this can be difficult to treat. Refer these patients to an allergist/clinical immunologist or hematologist.
Hematologist response:
There’s no such thing as a normal person with eosinophilia. Eosinophilia is abnormal. There are many conditions that are associated with this ailment. Eosinophilia associated with atopy or atopic dermatitis is generally not identified with other systemic or organ abnormalities. It may be associated with gastrointestinal disease: eosinophilic esophagitis, eosinophilic gastroenteritis and eosinophilic colitis.
Eosinophilia may be related to pulmonary infiltration: Loeffler’s syndrome, allergic angiitis and granulomatosis (Churg-Strauss syndrome), hypersensitivity vasculitis and allergic bronchopulmonary aspergillosis. This abnormality may be associated with neoplastic or myeloproliferative disorders: hypereosinophilic syndrome (HES), eosinophilic leukemia, lymphoma, bronchogenic carcinoma and many metastatic malignancies.
Patients with HES have persistent eosinophil count of 1.5 x 109/L for more than 6 months and generally have evidence of multiple organ involvement, especially cardiac dysfunction and central nervous system damage. It’s not the eosinophilia that requires referral for investigation, but rather the presence of associated conditions that determine the need for referral. If the problems are related to the gastrointestinal system, refer the patient to a gastroenterologist. When they’re associated with pulmonary abnormalities that you can’t identify, consult a respirologist and if there are additional hematological abnormalities, refer to a hematologist.
MORE ARTICLES
- June 2010
- November 2009
- October 2009
- 2008
- 2008 Update
