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Eosinophilia: A Brief Discussion Regarding Causes and Management

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Eosinophilia: A Brief Discussion Regarding Causes and Management

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Eosinophilia or a rise in the eosinophil count can occur due to allergy or skin infection, or due to HIV infection or cancer. Read the article to know more.

Medically reviewed by

iCliniq medical review team

Published At July 10, 2018
Reviewed AtAugust 8, 2023

Eosinophilia Definition

Eosinophilia is said to be present when the absolute eosinophil count is more than 400/cmm (some books mention eosinophilia when the absolute count is more than 500/cmm).

Etiology: I will describe in brief the causes of eosinophilia so that it will help in detecting the underlying cause of eosinophilia.

1. Allergic disorders: This is the first cause that has to be ruled out.

  • In asthma, bronchoconstriction occurs due to allergens like dust, pollen, mites, cold, etc. So, the patient is seen to have dyspnea problem as well.
  • Hay fever is a form of allergic rhinitis.
  • Drug allergy (Sulphonamides, Allopurinol, antiepileptic drugs, etc).
  • Food hypersensitivity.

2. Parasitic infestations: Following parasites can lead to high eosinophils.

3. Skin disease:

  • Eczema.
  • Scabies.
  • Pemphigus.
  • Psoriasis.
  • Contact dermatitis.

4. Pulmonary eosinophilia.

5. Miscellaneous:

  • Hodgkin's lymphoma.
  • ALL (acute lymphoblastic leukemia).
  • CML (chronic myeloid leukemia).
  • Eosinophilic gastritis.
  • Esophagitis.
  • HIV infection.


Eosinophilia Diagnosis

  • The diagnosis of eosinophilia is made by CBC (complete blood count) with a differential count.
  • After eosinophilia is confirmed, the underlying cause should be searched for.

  • For ruling out underlying cause, a medical history is taken and then accordingly investigations are done such as:

  1. Chest X-ray and spirometry for asthma.

  2. Liver and kidney profile test.

  3. Stool analysis and serological test for parasitic infestation.

  4. Allergy testing to find causative allergen.

  5. Peripheral smear examinations and bone marrow study to rule out a myeloproliferative neoplasm.

  6. Elisa test for HIV (human immunodeficiency virus).

So, according to need various tests are done.

Eosinophilia Treatment

- In allergy disorder, Corticosteroid or Montelukast or strong anti-inflammatory drug can be prescribed.

- In asthma, bronchodilator inhaler or nebulization also can be prescribed as per need.

- For parasites, Albendazole 400 mg is a good drug.

- For skin problem, according to the cause, treatment is done like for example, topical Betamethasone.

Footnote: Do not neglect high eosinophils in CBC. Rule out the underlying cause and accordingly, treatment is done. Hope this article is useful to you.

Frequently Asked Questions


What Is the Normal Eosinophil Count?

A normal healthy adult has fewer than 500 cells per microliter of blood. Counts higher than 500 and 1500 cells per microliter indicate eosinophilia and hypereosinophilia, respectively.


What Causes Eosinophilia?

Parasitic worm infection, autoimmune disorders, allergic reactions, seasonal allergies, eczema, cancer, ulcerative colitis, Crohn’s disease, drug reaction, asthma, scarlet fever, lupus, organ transplant rejection, adrenal gland deficiency, and fungal infections are some conditions where the eosinophil count is raised.


Is Eosinophilia Serious?

Eosinophilia can be due to less serious, serious, and potentially life-threatening causes. Hence detection of the cause for eosinophilia is essential for its treatment. Blood cancer, other cancers, DRESS (drug reaction with eosinophilia and systemic symptoms), and acute hypereosinophilic syndrome are severe life-threatening conditions.


Is Eosinophilia Treatable?

Eosinophilia is curable upon the correction of the underlying less serious cause. In case of a drug reaction, the drug should be stopped. Antiparasitic medications, steroids, eliminating potential allergens, etc., are cause-specific treatment methodologies. In primary eosinophilia, where there is increased eosinophils due to mutation, corticosteroids are used.


What Are the Triggers for Eosinophilia?

Allergic reactions, autoimmune disorders, skin disorders, tumors, parasitic and fungal infections, and adrenal disorders are potential triggers for eosinophilia.


Should I Worry About Eosinophilia?

Eosinophilia can be due to varied reasons. Although it narrows down, it does not pinpoint the cause. Hence it is advisable to correlate with the presenting symptoms and other lab tests as directed by the physician to reach a diagnosis of concern. Eosinophilia due to mutation, tumors, blood cancer, acute hypereosinophilic syndrome, some autoimmune disorders, and drug-induced hypersensitivity reactions are of high concern.


Are High Eosinophil Counts Dangerous?

A high eosinophil count indicates the presence of an underlying disease that needs to be diagnosed and corrected soon to arrest the progression and complication of the disease. Also, prolonged eosinophilia causes chronic inflammation in the body leading to tissue damage.


What Happens if You Have Zero Eosinophils?

There is no significant effect of deficient or zero eosinophils as the function of immunity and defense is compensated by other parts of the immune system. Usually, it does not cause any symptoms and is detected in a routine complete blood count.


Should I Worry About Eosinopenia?

A low eosinophil count or eosinopenia is usually not of serious concern unless it is accompanied by an underlying cause of excessive cortisol, sepsis (bloodstream infection), and alcoholism which are of concern.


Which Foods Trigger Eosinophilia?

Dairy products, soy, wheat, eggs, fish, shellfish, peanuts, and tree nuts cause allergies in some people, increasing the eosinophil count.


Will Stress Cause Eosinophilia?

Stress and anxiety lead to increased cortisol levels which in turn cause reduced eosinophil count.


Does Eosinophilia Cause Tiredness?

Eosinophilia by itself does not cause tiredness, but the cause for eosinophilia may have tiredness as one of its symptoms as in cancer, hypereosinophilic syndrome, etc. Also, a rare disorder called eosinophilia-myalgia syndrome presents fatigue as its main symptom.


Can UTI Increase My Eosinophil Counts?

DRESS (drug reaction with eosinophilia and systemic symptoms) can cause high eosinophils due to medication for urinary tract infection. Also, a high eosinophil count is observed in eosinophilic cystitis.


What parasites cause eosinophilia?

Nematodes like hookworm, Cysticercus, Ascaris, Strongyloides, Echinococcus, Filariae, flukes like Schistosoma, Paragonimus westermani, Fasciola, protozoans like Isospora belli, Dientamoeba fragilis, and Sarcocystis cause infection and eosinophilia.


Can Bacterial Infection Cause Eosinophilia?

Bacterial and viral infections and sepsis cause decreased eosinophils or eosinopenia. Tuberculosis causes eosinophilia. Parasitic infections mainly cause eosinophilia.


How to Manage High Eosinophil Counts?

Treating the underlying cause of high eosinophils and discontinuation of drug in drug allergy, adequate treatment for asthma, eczema, and allergies, anti-parasitic medications, and avoiding potential allergens reduce eosinophilia. Corticosteroid, Imatinib, Hydroxyurea, and Interferon Alpha are the current choice of drug therapies to treat eosinophilia.


What Is Meant by Pediatric Hypereosinophilic syndrome?

Eosinophil counts above 1500 per microliter are known as hypereosinophilia. Persistent hypereosinophilia with organ involvement causes hypereosinophilic syndrome. Most commonly, the respiratory tract, central nervous system, skin, and heart are involved. This is a rare entity in children and can be due to chromosomal abnormalities or myeloproliferative disorders and cancer. Treatment options include steroids, Vincristine, Mepolizumab, Hydroxyurea, Interferon Alpha, and Imatinib.
Dr. Goswami Parth Rajendragiri
Dr. Goswami Parth Rajendragiri



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