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Current Pediatric Reviews

Editor-in-Chief

ISSN (Print): 1573-3963
ISSN (Online): 1875-6336

Review Article

Practical Approach to Children Presenting with Eosinophila and Hypereosinophilia

Author(s): Giorgio Costagliola, Serena Di Marco, Pasquale Comberiati, Sofia D’Elios, Nino Petashvili, Maria Elisa Di Cicco and Diego Peroni*

Volume 16 , Issue 2 , 2020

Page: [81 - 88] Pages: 8

DOI: 10.2174/1573396315666191114150438

Price: $65

Abstract

Eosinophilia is not a rare finding in clinical practice, and often poses problems in terms of etiologic research and differential diagnosis. Peripheral eosinophilia is defined by a blood eosinophil count > 500 cells/μL. It is classified into mild (500-1500 cells/μl), moderate (1500-5000 cells/μl) and severe for an eosinophil count > 5000 cells /μl. The term "hypereosinophilia” defines a condition characterized by a blood eosinophil count >1500 cells/μl in at least two consecutive tests made with a minimum of a 4-week interval. The causes of eosinophilia are various, and can be summarized by the acronym “APLV” which refers to Allergic disorders, Parasitic infections, Leukemia/ Lymphomas (and solid tumors) and Vasculitis-Immunodeficiency diseases, with allergic disorders and parasitic infections representing the most commonly identified causes. Allergic disorders are usually associated with mild eosinophilia, whereas values >20.000 cell/μl are highly suggestive for myeloproliferative disorders. Eosinophils may also be directly responsible for organ damage, mainly at cardiac, pulmonary and cutaneous level, deriving from the release of the granule products, of lipidic mediators and cytokines. Therefore, in the physician’s approach to a patient with persistent hypereosinophilia, it is also important to investigate the presence of organ involvement. In this review, we propose a diagnostic algorithm for children presenting with either blood eosinophilia or hypereosinophilia. This algorithm focuses on the patient’s history and clinical manifestations as the first step and the level and persistence of blood eosinophilia as the second, and this can help the physician to identify patients presenting with an elevated blood eosinophil count that need further laboratory or instrumental investigations.

Keywords: Allergy, asthma, atopic dermatitis, DRESS, eosinophil, eosinophilia, hypereosinophylic syndromes, parasites.

Graphical Abstract
[1]
Valent P, Klion AD, Horny HP, et al. Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes. J Allergy Clin Immunol 2012; 130(3): 607-12.e9.
[http://dx.doi.org/10.1016/j.jaci.2012.02.019] [PMID: 22460074]
[2]
Roufosse F, Weller PF. Practical approach to the patient with hypereosinophilia. J Allergy Clin Immunol 2010; 126(1): 39-44.
[http://dx.doi.org/10.1016/j.jaci.2010.04.011] [PMID: 20538328]
[3]
Rosenberg HF, Dyer KD, Foster PS. Eosinophils: changing perspectives in health and disease. Nat Rev Immunol 2013; 13(1): 9-22.
[http://dx.doi.org/10.1038/nri3341] [PMID: 23154224]
[4]
Collins PD, Marleau S, Griffiths-Johnson DA, Jose PJ, Williams TJ. Cooperation between interleukin-5 and the chemokine eotaxin to induce eosinophil accumulation in vivo. J Exp Med 1995; 182(4): 1169-74.
[http://dx.doi.org/10.1084/jem.182.4.1169] [PMID: 7561691]
[5]
Blanchard C, Rothenberg ME. Biology of the eosinophil. Adv Immunol 2009; 101: 81-121.
[http://dx.doi.org/10.1016/S0065-2776(08)01003-1] [PMID: 19231593]
[6]
Akuthota P, Weller PF. Spectrum of Eosinophilic End-Organ Manifestations. Immunol Allergy Clin North Am 2015; 35(3): 403-11.
[http://dx.doi.org/10.1016/j.iac.2015.04.002] [PMID: 26209892]
[7]
Mejia R, Nutman TB. Evaluation and differential diagnosis of marked, persistent eosinophilia. Semin Hematol 2012; 49(2): 149-59.
[http://dx.doi.org/10.1053/j.seminhematol.2012.01.006] [PMID: 22449625]
[8]
Brigden ML. A practical workup for eosinophilia. you can investigate the most likely causes right in your office. Postgrad Med 1999; 105(3): 193-210.
[http://dx.doi.org/10.3810/pgm.1999.03.638]
[9]
Chen YY, Khoury P, Ware JM, et al. Marked and persistent eosinophilia in the absence of clinical manifestations. J Allergy Clin Immunol 2014; 133(4): 1195-202.
[http://dx.doi.org/10.1016/j.jaci.2013.06.037] [PMID: 23987798]
[10]
Ellis AK, Keith PK. Nonallergic rhinitis with eosinophilia syndrome and related disorders. Clin Allergy Immunol 2007; 19: 87-100.
[PMID: 17153009]
[11]
Green RH, Brightling CE, McKenna S, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet 2002; 360(9347): 1715-21.
[http://dx.doi.org/10.1016/S0140-6736(02)11679-5] [PMID: 12480423]
[12]
Newby C, Agbetile J, Hargadon B, et al. Lung function decline and variable airway inflammatory pattern: longitudinal analysis of severe asthma. J Allergy Clin Immunol 2014; 134(2): 287-94.
[http://dx.doi.org/10.1016/j.jaci.2014.04.005] [PMID: 24928647]
[13]
Reddel HK, Bateman ED, Becker A, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J 2015; 46(3): 622-39.
[http://dx.doi.org/10.1183/13993003.00853-2015] [PMID: 26206872]
[14]
Tran TN, Khatry DB, Ke X, Ward CK, Gossage D. High blood eosinophil count is associated with more frequent asthma attacks in asthma patients. Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, &. Immunology 2014; 113(1): 19-24.
[15]
Price DB, Rigazio A, Campbell JD, et al. Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study. Lancet Respir Med 2015; 3(11): 849-58.
[http://dx.doi.org/10.1016/S2213-2600(15)00367-7] [PMID: 26493938]
[16]
Spector SL, Tan RA. Is a single blood eosinophil count a reliable marker for "eo-sinophilic asthma? J Asthma : official journal of the Association for the Care of Asthma 2012; 49(8): 807-10..
[17]
Bodini A, Peroni D, Loiacono A, et al. Exhaled nitric oxide daily evaluation is effective in monitoring exposure to relevant allergens in asthmatic children. Chest 2007; 132(5): 1520-5.
[http://dx.doi.org/10.1378/chest.07-1025] [PMID: 17890466]
[18]
Caffarelli C, Dascola CP, Peroni D, et al. Airway acidification in childhood asthma exacerbations. Allergy Asthma Proc 2014; 35(3): 51-6.
[http://dx.doi.org/10.2500/aap.2014.35.3740] [PMID: 24801459]
[19]
Tenero L, Zaffanello M, Piazza M, Piacentini G. Measuring Airway Inflammation in Asthmatic Children. Front Pediatr 2018; 6: 196.
[http://dx.doi.org/10.3389/fped.2018.00196] [PMID: 30035104]
[20]
Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R, et al. Clin Exp Allergy. Journal of the British Society for Allergy and Clinical Immunology 2013; 43(8): 850-73.
[http://dx.doi.org/10.1111/cea.12141]
[21]
Giovannini-Chami L, Blanc S, Hadchouel A, et al. Eosinophilic pneumonias in children: A review of the epidemiology, diagnosis, and treatment. Pediatr Pulmonol 2016; 51(2): 203-16.
[http://dx.doi.org/10.1002/ppul.23368] [PMID: 26716396]
[22]
Peroni DG, Bonomo B, Casarotto S, Boner AL, Piacentini GL. How changes in nutrition have influenced the development of allergic diseases in childhood. Ital J Pediatr 2012; 38: 22.
[http://dx.doi.org/10.1186/1824-7288-38-22] [PMID: 22651129]
[23]
Minniti F, Comberiati P, Munblit D, et al. Breast-milk characteristics protecting against allergy. Endocr Metab Immune Disord Drug Targets 2014; 14(1): 9-15.
[http://dx.doi.org/10.2174/1871530314666140121145045] [PMID: 24450452]
[24]
Clin Exp Allergy : journal of the British Society for Allergy and Clinical Immunology 2006; 36(5): 614-8..
[25]
Kiehl P, Falkenberg K, Vogelbruch M, Kapp A. Tissue eosinophilia in acute and chronic atopic dermatitis: a morphometric approach using quantitative image analysis of immunostaining. Br J Dermatol 2001; 145(5): 720-9.
[http://dx.doi.org/10.1046/j.1365-2133.2001.04456.x] [PMID: 11736895]
[26]
Leung DY, Guttman-Yassky E. Deciphering the complexities of atopic dermatitis: shifting paradigms in treatment approaches. J Allergy Clin Immunol 2014; 134(4): 769-79.
[http://dx.doi.org/10.1016/j.jaci.2014.08.008] [PMID: 25282559]
[27]
Simon D, Braathen LR, Simon HU. Eosinophils and atopic dermatitis. Allergy 2004; 59(6): 561-70.
[http://dx.doi.org/10.1111/j.1398-9995.2004.00476.x] [PMID: 15147438]
[28]
Uehara M, Izukura R, Sawai T. Blood eosinophilia in atopic dermatitis. Clin Exp Dermatol 1990; 15(4): 264-6.
[http://dx.doi.org/10.1111/j.1365-2230.1990.tb02086.x] [PMID: 2208775]
[29]
Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med 2004; 351(9): 940-1.
[http://dx.doi.org/10.1056/NEJM200408263510924] [PMID: 15329438]
[30]
Mehta P, Furuta GT. Eosinophils in gastrointestinal disorders: eosinophilic gastrointestinal diseases, celiac disease, inflammatory bowel diseases, and parasitic infections. Immunol Allergy Clin North Am 2015; 35(3): 413-37.
[http://dx.doi.org/10.1016/j.iac.2015.04.003] [PMID: 26209893]
[31]
Aceves SS, Newbury RO, Dohil R, Schwimmer J, Bastian JF. Distinguishing eosinophilic esophagitis in pediatric patients: clinical, endoscopic, and histologic features of an emerging disorder. J Clin Gastroenterol 2007; 41(3): 252-6.
[http://dx.doi.org/10.1097/01.mcg.0000212639.52359.f1] [PMID: 17426462]
[32]
Arias A, Lucendo AJ. Expert Rev Gastroenterol Hepatol 2019 Feb;13(2):99-117..
[http://dx.doi.org/10.1080/17474124.2019.1546120]
[33]
Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TA. Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, &. Immunology 2010; 104(6): 496-502.
[34]
Curtis C, Ogbogu PU. Evaluation and differential diagnosis of persistent marked eosinophilia. Immunol Allergy Clin North Am 2015; 35(3): 387-402.
[http://dx.doi.org/10.1016/j.iac.2015.04.001] [PMID: 26209891]
[35]
Demoly P, Adkinson NF, Brockow K, et al. International Consensus on drug allergy. Allergy 2014; 69(4): 420-37.
[http://dx.doi.org/10.1111/all.12350] [PMID: 24697291]
[36]
Kardaun SH, Sidoroff A, Valeyrie-Allanore L, 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; 156(3): 609-11.
[http://dx.doi.org/10.1111/j.1365-2133.2006.07704.x] [PMID: 17300272]
[37]
Schulte C, Krebs B, Jelinek T, Nothdurft HD, von Sonnenburg F, Löscher T. Diagnostic significance of blood eosinophilia in returning travelers. Clin Infect Dis 2002; 34(3): 407-11.
[http://dx.doi.org/10.1086/338026] [PMID: 11753824]
[38]
Checkley AM, Chiodini PL, Dockrell DH, et al. Eosinophilia in returning travellers and migrants from the tropics: UK recommendations for investigation and initial management. J Infect 2010; 60(1): 1-20.
[http://dx.doi.org/10.1016/j.jinf.2009.11.003] [PMID: 19931558]
[39]
Lowe D, Jorizzo J, Hutt MS. Tumour-associated eosinophilia: a review. J Clin Pathol 1981; 34(12): 1343-8.
[http://dx.doi.org/10.1136/jcp.34.12.1343] [PMID: 7035499]
[40]
Roufosse F, Garaud S, de Leval L. Lymphoproliferative disorders associated with hypereosinophilia. Semin Hematol 2012; 49(2): 138-48.
[http://dx.doi.org/10.1053/j.seminhematol.2012.01.003] [PMID: 22449624]
[41]
Gotlib J. World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management. Am J Hematol 2015; 90(11): 1077-89.
[http://dx.doi.org/10.1002/ajh.24196] [PMID: 26486351]
[42]
Valent P, Sperr WR, Sotlar K, et al. The serum tryptase test: an emerging robust biomarker in clinical hematology. Expert Rev Hematol 2014; 7(5): 683-90.
[http://dx.doi.org/10.1586/17474086.2014.955008] [PMID: 25169217]
[43]
Fina A, Dubus JC, Tran A, Derelle J, Reix P. Eosinophilic granulomatosis with polyangiitis in children: Da-ta from the French RespiRare( R) cohort. 2018; 53(12): 1640-50..
[44]
Gendelman S, Zeft A, Spalding SJ. Childhood-onset eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome): a contemporary single-center cohort. J Rheumatol 2013; 40(6): 929-35.
[http://dx.doi.org/10.3899/jrheum.120808] [PMID: 23637321]
[45]
Ponsford MJ, Klocperk A, Pulvirenti F, Dalm V, Milota T. Hyper- IgE in the allergy clinic--when is it primary immunode-ficiency? 2018; 73(11): 2122-36..
[46]
Navabi B, Upton JE. Primary immunodeficiencies associated with eosinophilia. Allergy Asthma Clin Immunol 2016; 12: 27.
[http://dx.doi.org/10.1186/s13223-016-0130-4] [PMID: 27222657]
[47]
Chan SK, Gelfand EW. Primary Immunodeficiency Masquerading as Allergic Disease. Immunol Allergy Clin North Am 2015; 35(4): 767-78.
[http://dx.doi.org/10.1016/j.iac.2015.07.008] [PMID: 26454318]
[48]
Ogbogu PU, Bochner BS, Butterfield JH, et al. Hypereosinophilic syndrome: a multicenter, retrospective analysis of clinical characteristics and response to therapy. J Allergy Clin Immunol 2009; 124(6): 1319-25.e3.
[http://dx.doi.org/10.1016/j.jaci.2009.09.022] [PMID: 19910029]
[49]
Cogan E, Roufosse F. Clinical management of the hypereosinophilic syndromes. Expert Rev Hematol 2012; 5(3): 275-89.
[http://dx.doi.org/10.1586/ehm.12.14] [PMID: 22780208]
[50]
Gotlib J, Cools J, Malone JM III, Schrier SL, Gilliland DG, Coutré SE. The FIP1L1-PDGFRalpha fusion tyrosine kinase in hypereosinophilic syndrome and chronic eosinophilic leukemia: implications for diagnosis, classification, and management. Blood 2004; 103(8): 2879-91.
[http://dx.doi.org/10.1182/blood-2003-06-1824] [PMID: 15070659]

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