Approach to Patients with Eosinophilia

Fei Li Kuang, Fei Li Kuang

Abstract

Physicians may encounter blood or tissue eosinophilia through a routine complete blood count with differential or a tissue pathology report. In this article, the basic biology of eosinophils is reviewed and definitions of blood eosinophilia, as well as the challenges of defining tissue eosinophilia, are discussed. Conditions associated with eosinophilia are briefly discussed as well as a general approach to evaluating eosinophilia. Future challenges include determining which eosinophil-associated diseases benefit from eosinophil-targeted therapy and identifying biomarkers for disease activity and diagnosis.

Keywords: Biologics; Corticosteroids; Eosinophil; Eosinophil granule proteins; Hypereosinophilia; IL-5.

Published by Elsevier Inc.

References

    1. Sakula A Charcot-Leyden crystals and Curschmann spirals in asthmatic sputum. Thorax. 1986. July;41(7):503–7.
    1. Davoine F, Lacy P. Eosinophil cytokines, chemokines, and growth factors: emerging roles in immunity. Front Immunol. 2014. November 10;5:570.
    1. Melo RCN, Weller PF. Unraveling the complexity of lipid body organelles in human eosinophils. J Leukoc Biol. 2014. November;96(5):703–12.
    1. Spencer LA, Bonjour K, Melo RCN, Weller PF. Eosinophil secretion of granule-derived cytokines. Front Immunol. 2014. October 27;5:496.
    1. Ueki S, Tokunaga T, Melo RCN, Saito H, Honda K, Fukuchi M, et al. Charcot-Leyden crystal formation is closely associated with eosinophil extracellular trap cell death. Blood. 2018. November 15;132(20):2183–7.
    1. Sher A, Butterworth AE, Colley DG, Cook JA, Freeman GL, Jordan P. Immune responses during human schistosomiasis mansoni. II. Occurrence of eosinophil-dependent cytotoxic antibodies in relation to intensity and duration of infection. Am J Trop Med Hyg. 1977. September;26(5 Pt 1):909–16.
    1. Moser G, Sher A. Studies of the antibody-dependent killing of schistosomula of Schistosoma mansoni employing haptenic target antigens. II. In vitro killing of TNP-schistosomula by human eosinophils and neutrophils. J Immunol. 1981. March;126(3):1025–9.
    1. Lee JJ, Rosenberg HF, editors. Eosinophils in Health and Disease. Elsevier; 2012.
    1. Weller PF, Spencer LA. Functions of tissue-resident eosinophils. Nat Rev Immunol. 2017. December;17(12):746–60.
    1. Hilderink JM, Klinkenberg LJJ, Aakre KM, de Wit NCJ, Henskens YMC, van der Linden N, et al. Within-day biological variation and hour-to-hour reference change values for hematological parameters. Clin Chem Lab Med. 2017. June 27;55(7):1013–24.
    1. Sennels HP, Jørgensen HL, Hansen A-LS, Goetze JP, Fahrenkrug J. Diurnal variation of hematology parameters in healthy young males: the Bispebjerg study of diurnal variations. Scand J Clin Lab Invest. 2011. November;71(7):532–41.
    1. Chen Y-YK, Khoury P, Ware JM, Holland-Thomas NC, Stoddard JL, Gurprasad S, et al. Marked and persistent eosinophilia in the absence of clinical manifestations. J Allergy Clin Immunol. 2014. April;133(4):1195–202.
    1. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007. October;133(4):1342–63.
    1. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011. July;128(1):3–20.e6; quiz 21.
    1. Molina-Infante J, Bredenoord AJ, Cheng E, Dellon ES, Furuta GT, Gupta SK, et al. Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis. Gut. 2016. March;65(3):524–31.
    1. Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference. Gastroenterology. 2018. September 6;155(4):1022–1033.e10.
    1. DeBrosse CW, Case JW, Putnam PE, Collins MH, Rothenberg ME. Quantity and distribution of eosinophils in the gastrointestinal tract of children. Pediatr Dev Pathol. 2006. June;9(3):210–8.
    1. Lwin T, Melton SD, Genta RM. Eosinophilic gastritis: histopathological characterization and quantification of the normal gastric eosinophil content. Mod Pathol. 2011. April;24(4):556–63.
    1. Khoury P, Akuthota P, Ackerman SJ, Arron JR, Bochner BS, Collins MH, et al. Revisiting the NIH Taskforce on the Research needs of Eosinophil-Associated Diseases (RE-TREAD). J Leukoc Biol. 2018. April 19;104(1):69–83.
    1. O’Connell EM, Nutman TB. Eosinophilia in infectious diseases. Immunol Allergy Clin North Am. 2015. August;35(3):493–522.
    1. Chou A, Serpa JA. Eosinophilia in patients infected with human immunodeficiency virus. Curr HIV/AIDS Rep. 2015. September;12(3):313–6.
    1. Al Mohajer M, Villarreal-Williams E, Andrade RA, Giordano TP, Serpa JA. Eosinophilia and associated factors in a large cohort of patients infected with human immunodeficiency virus. South Med J. 2014. September;107(9):554–8.
    1. Flores M, Merino-Angulo J, Tanago JG, Aquirre C. Late generalized tuberculosis and eosinophilia. Arch Intern Med. 1983. January;143(1):182.
    1. Vijayan VK, Reetha AM, Jawahar MS, Sankaran K, Prabhakar R. Pulmonary eosinophilia in pulmonary tuberculosis. Chest. 1992. June;101(6):1708–9.
    1. Driss V, Legrand F, Hermann E, Loiseau S, Guerardel Y, Kremer L, et al. TLR2-dependent eosinophil interactions with mycobacteria: role of alpha-defensins. Blood. 2009. April 2;113(14):3235–44.
    1. Pfeffer PE, Hopkins S, Cropley I, Lowe DM, Lipman M. An association between pulmonary Mycobacterium avium-intracellulare complex infections and biomarkers of Th2-type inflammation. Respir Res. 2017. May 15;18(1):93.
    1. Herrick JA, Legrand F, Gounoue R, Nchinda G, Montavon C, Bopda J, et al. Posttreatment Reactions After Single-Dose Diethylcarbamazine or Ivermectin in Subjects With Loa loa Infection. Clin Infect Dis. 2017. April 15;64(8):1017–25.
    1. Rajamanickam A, Munisankar S, Bhootra Y, Dolla CK, Nutman TB, Babu S. Elevated Systemic Levels of Eosinophil, Neutrophil, and Mast Cell Granular Proteins in Strongyloides Stercoralis Infection that Diminish following Treatment. Front Immunol. 2018. February 9;9:207.
    1. Nutman TB, Miller KD, Mulligan M, Ottesen EA. Loa loa infection in temporary residents of endemic regions: recognition of a hyperresponsive syndrome with characteristic clinical manifestations. J Infect Dis. 1986. July;154(1):10–8.
    1. Thaden J, Cassar A, Vaa B, Phillips S, Burkhart H, Aubry M, et al. Eosinophilic endocarditis and Strongyloides stercoralis. Am J Cardiol. 2013. August 1;112(3):461–2.
    1. Romagosa R, Kapoor S, Sanders J, Berman B. Inpatient Adverse Cutaneous Drug Eruptions and Eosinophilia. | Allergy and Clinical Immunology | JAMA Dermatology | JAMA Network. Arch Dermatol. 2001. April 1;
    1. Kuruvilla M, Khan DA. Eosinophilic Drug Allergy. Clin Rev Allergy Immunol. 2016. April;50(2):228–39.
    1. Ramírez E, Medrano-Casique N, Tong HY, Bellón T, Cabañas R, Fiandor A, et al. Eosinophilic drug reactions detected by a prospective pharmacovigilance programme in a tertiary hospital. Br J Clin Pharmacol. 2017;83(2):400–15.
    1. Ogawa K, Morito H, Hasegawa A, Miyagawa F, Kobayashi N, Watanabe H, et al. Elevated serum thymus and activation-regulated chemokine (TARC/CCL17) relates to reactivation of human herpesvirus 6 in drug reaction with eosinophilia and systemic symptoms (DRESS)/drug-induced hypersensitivity syndrome (DIHS). Br J Dermatol. 2014. August 2;171(2):425–7.
    1. Tashiro Y, Azukizawa H, Asada H, Niihara H, Morita E, Yamauchi T, et al. Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms due to lamotrigine differs from that due to other drugs. J Dermatol. 2019. March;46(3):226–33.
    1. Kardaun SH, Sidoroff A, Valeyrie-Allanore L, Halevy S, Davidovici BB, Mockenhaupt M, et al. Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol. 2007. March;156(3):609–11.
    1. Kardaun SH, Sekula P, Valeyrie-Allanore L, Liss Y, Chu CY, Creamer D, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol. 2013. November;169(5):1071–80.
    1. Chen Y-C, Chiu H-C, Chu C-Y. Drug reaction with eosinophilia and systemic symptoms: a retrospective study of 60 cases. Arch Dermatol. 2010. December;146(12):1373–9.
    1. Cacoub P, Musette P, Descamps V, Meyer O, Speirs C, Finzi L, et al. The DRESS syndrome: a literature review. Am J Med. 2011. July;124(7):588–97.
    1. Eosinophilia-Myalgia Syndrome—New Mexico. JAMA. 1989. December 8;262(22):3116.
    1. Böhm A, Födinger M, Wimazal F, Haas OA, Mayerhofer M, Sperr WR, et al. Eosinophilia in systemic mastocytosis: clinical and molecular correlates and prognostic significance. J Allergy Clin Immunol. 2007. July;120(1):192–9.
    1. Maric I, Robyn J, Metcalfe DD, Fay MP, Carter M, Wilson T, et al. KIT D816V-associated systemic mastocytosis with eosinophilia and FIP1L1/PDGFRA-associated chronic eosinophilic leukemia are distinct entities. J Allergy Clin Immunol. 2007. September;120(3):680–7.
    1. Kalaycioglu ME, Bolwell BJ. Eosinophilia after allogeneic bone marrow transplantation using the busulfan and cyclophosphamide preparative regimen. Bone Marrow Transplant. 1994. July;14(1):113–5.
    1. Bush JW, Mohammad S, Melin-Aldana H, Kagalwalla AF, Arva NC. Eosinophilic density in graft biopsies positive for rejection and blood eosinophil count can predict development of post-transplant digestive tract eosinophilia. Pediatr Transplant. 2016. June;20(4):540–51.
    1. Wechsler ME, Akuthota P, Jayne D, Khoury P, Klion A, Langford CA, et al. Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis. N Engl J Med. 2017. May 18;376(20):1921–32.
    1. Williams KW, Milner JD, Freeman AF. Eosinophilia Associated with Disorders of Immune Deficiency or Immune Dysregulation. Immunol Allergy Clin North Am. 2015. August;35(3):523–44.
    1. Milner JD, Ward JM, Keane-Myers A, Paul WE. Lymphopenic mice reconstituted with limited repertoire T cells develop severe, multiorgan, Th2-associated inflammatory disease. Proc Natl Acad Sci USA. 2007. January 9;104(2):576–81.
    1. Lucendo AJ, Arias Á, González-Cervera J, Yagüe-Compadre JL, Guagnozzi D, Angueira T, et al. Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease. J Allergy Clin Immunol. 2013. March;131(3):797–804.
    1. Molina-Infante J, Arias Á, Alcedo J, Garcia-Romero R, Casabona-Frances S, Prieto-Garcia A, et al. Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2–4-6 study. J Allergy Clin Immunol. 2018. April;141(4):1365–72.
    1. Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2006. September;4(9):1097–102.
    1. Castro M, Corren J, Pavord ID, Maspero J, Wenzel S, Rabe KF, et al. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. N Engl J Med. 2018. June 28;378(26):2486–96.
    1. Valent P, Klion AD, Horny H-P, Roufosse F, Gotlib J, Weller PF, et al. Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes. J Allergy Clin Immunol. 2012. September 1;130(3):607–612.e9.
    1. Klion AD. How I treat hypereosinophilic syndromes. Blood. 2015. August 27;126(9):1069–77.
    1. Prakash Babu S, Chen YYK, Bonne-Annee S, Yang J, Maric I, Myers TG, et al. Dysregulation of interleukin 5 expression in familial eosinophilia. Allergy. 2017. September;72(9):1338–45.
    1. Klion AD, Law MA, Riemenschneider W, McMaster ML, Brown MR, Horne M, et al. Familial eosinophilia: a benign disorder? Blood. 2004. June 1;103(11):4050–5.
    1. Kuang FL, Fay MP, Ware J, Wetzler L, Holland-Thomas N, Brown T, et al. Long-Term Clinical Outcomes of High-Dose Mepolizumab Treatment for Hypereosinophilic Syndrome. J Allergy Clin Immunol Pract. 2018. May 8;6(5):1518–1527.e5.
    1. Ogbogu PU, Bochner BS, Butterfield JH, Gleich GJ, Huss-Marp J, Kahn JE, et al. Hypereosinophilic syndrome: a multicenter, retrospective analysis of clinical characteristics and response to therapy. J Allergy Clin Immunol. 2009. December;124(6):1319–25.e3.
    1. Pongdee T, Khoury P, Klion AD. Myeloproliferative hypereosinophilic syndrome: retrospective analysis of cytogenetic and molecular features. Journal of Allergy and Clinical Immunology. 2018. February;141(2):AB277.
    1. Kuang FL, Legrand F, Makiya M, Ware J, Wetzler L, Brown T, et al. Benralizumab for PDGFRA-Negative Hypereosinophilic Syndrome. N Engl J Med. 2019. April 4;380(14):1336–46.
    1. Legrand F, Klion AD. Biologic therapies targeting eosinophils: current status and future prospects. J Allergy Clin Immunol Pract. 2015. April;3(2):167–74.
    1. Panch SR, Bozik ME, Brown T, Makiya M, Prussin C, Archibald DG, et al. Dexpramipexole as an oral steroid-sparing agent in hypereosinophilic syndromes. Blood. 2018. August 2;132(5):501–9.
    1. Laidlaw TM, Prussin C, Panettieri RA, Lee S, Ferguson BJ, Adappa ND, et al. Dexpramipexole depletes blood and tissue eosinophils in nasal polyps with no change in polyp size. Laryngoscope. 2019. February;129(2):E61–6.
    1. Roufosse FE, Kahn J-E, Gleich GJ, Schwartz LB, Singh AD, Rosenwasser LJ, et al. Long-term safety of mepolizumab for the treatment of hypereosinophilic syndromes. J Allergy Clin Immunol. 2013. February;131(2):461–7.e1.
    1. Lee JJ, Jacobsen EA, McGarry MP, Schleimer RP, Lee NA. Eosinophils in health and disease: the LIAR hypothesis. Clin Exp Allergy. 2010. April;40(4):563–75.

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