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Eosinophilia: A Brief Discussion Regarding Causes and Management

Author: Dr. Parth R Goswami R Goswami - Blood Health
Last reviewed at: 07.Sep.2018  

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Abstract:

Eosinophils are round to oval cells having a bilobed nucleus with orange granules in the cytoplasm. Along with the IgE antibody, it mediates allergic reactions, that is, type-1 hypersensitivity reactions. So, increased eosinophil count is suggestive of mainly allergic reaction. Its normal range in different leukocyte counts is only 1 to 6 % (40 to 400/cmm). In an allergic reaction, eosinophils along with mast cells, play a significant role and its content like digestive enzymes and cytotoxic protein can lead to tissue damage as well.
Image: Eosinophilia: A Brief Discussion Regarding Causes and Management

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.

  • Ascariasis.
  • Ancylostoma duodenale.
  • Enterobiasis.
  • Taenia solium.
  • Filariasis.
  • Hydatid cyst.

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.
  • Certain fungal infection.
  • AML in few cases.

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.

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.

For more information consult an allergy management specialist online --> https://www.icliniq.com/ask-a-doctor-online/allergy-specialist/allergy-management


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