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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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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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