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Eosinophilia – Causes, Symptoms and Treatment

Eosinophilia refers to an elevated number of eosinophils in the blood. It may indicate allergies, parasitic infections, or rare blood disorders.

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Things worth knowing about "Eosinophilia"

Eosinophilia refers to an elevated number of eosinophils in the blood. It may indicate allergies, parasitic infections, or rare blood disorders.

What is Eosinophilia?

Eosinophilia is a finding in a blood count where the number of eosinophils – a specific type of white blood cell (leukocyte) – is abnormally elevated. Under normal circumstances, eosinophils make up approximately 1–5% of all white blood cells, corresponding to an absolute count of about 100–500 cells per microliter of blood. Eosinophilia is diagnosed when this count persistently exceeds 500 cells per microliter.

Depending on severity, eosinophilia is classified as:

Mild eosinophilia: 500–1,500 cells/µl
Moderate eosinophilia: 1,500–5,000 cells/µl
Severe hypereosinophilia: above 5,000 cells/µl

Causes

Eosinophilia is not a disease in itself but a laboratory finding that may point to various underlying conditions. The most common causes include:

Allergic and Atopic Conditions

Allergic asthma
Allergic rhinitis (hay fever)
Atopic dermatitis (eczema)
Food allergies

Parasitic Infections

Tissue-invasive parasites (e.g., Toxocara, Ascaris, Trichinella)
Tropical infections (e.g., filariasis, schistosomiasis)

Drug Reactions

Certain antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), or antiepileptic medications can trigger eosinophilia.

Autoimmune and Inflammatory Diseases

Eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome)
Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
Systemic lupus erythematosus

Malignant Conditions

Hodgkin lymphoma
Chronic eosinophilic leukemia
Other hematological neoplasms

Idiopathic Hypereosinophilic Syndrome (HES)

In hypereosinophilic syndrome, no identifiable cause can be found for the persistently elevated eosinophil count. The condition can lead to organ damage affecting the heart, lungs, skin, and nervous system.

Symptoms

Many individuals have no symptoms initially, as eosinophilia is often detected incidentally during routine blood tests. Symptoms typically arise from the underlying condition or, in severe cases, from organ damage caused by eosinophil infiltration:

Skin rash, itching
Cough, shortness of breath, asthma-like symptoms
Abdominal pain, diarrhea
Fever, fatigue, weight loss
Cardiac complications (e.g., eosinophilic myocarditis in severe cases)
Neurological symptoms (numbness, tingling)

Diagnosis

Eosinophilia is diagnosed through a complete blood count with differential. To identify the underlying cause, the following investigations may be performed depending on clinical suspicion:

Stool examination for parasites and eggs
Serological tests for parasites and allergens (total and specific IgE)
Imaging studies (X-ray, CT scan, ultrasound)
Bone marrow biopsy if a hematological disorder is suspected
Organ biopsies (e.g., heart, lung) if organ involvement is present
Genetic testing (e.g., FIP1L1-PDGFRA fusion in myeloid eosinophilia)

Treatment

Treatment is directed at the underlying cause of eosinophilia:

Allergies: Antihistamines, corticosteroids, allergen avoidance
Parasitic infections: Antiparasitic medications (e.g., albendazole, ivermectin)
Autoimmune diseases: Immunosuppressants, corticosteroids
Hematological malignancies: Imatinib (for FIP1L1-PDGFRA-positive disease), chemotherapy
Hypereosinophilic syndrome: Corticosteroids as first-line therapy; in severe cases, monoclonal antibodies such as mepolizumab (anti-IL-5)

If eosinophilia is drug-induced, the causative medication should be discontinued.

References

Klion A.D. - Eosinophilia: a pragmatic approach to diagnosis and treatment. In: Hematology Am Soc Hematol Educ Program. 2015;2015:92-97. PubMed PMID: 26637712.
Gotlib J. - World Health Organization-defined eosinophilic disorders: 2022 update on diagnosis, risk stratification, and management. Am J Hematol. 2022;97(12):1547-1571.
World Health Organization (WHO) - Soil-transmitted helminth infections. Available at: www.who.int

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