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956 Part VII: Neutrophils, Eosinophils, Basophils, and Mast Cells Chapter 62: Eosinophils and Related Disorders 957

TABLE 62–4. Causes of an Eosinophilia (Continued)
Frequency of Cause Usual Degree of
Disease of Eosinophilia Eosinophilia Comment
RESPIRATORY TRACT (FOR ASTHMA SEE ALLERGIC DISEASES)
Eosinophilic granulomatosis Rare Moderate to high Syndrome of eosinophilic vasculitis and asthma
with polyangiitis
Chronic eosinophilic Uncommon Mild to high Syndrome of eosinophilia and chest x-ray shadowing
pneumonia
Bronchiectasis/cardiac Common Mild Often associated with asthma or allergic fungal airway disease
failure
SKIN DISEASES (FOR ATOPIC DERMATITIS SEE ALLERGIC DISEASES)
Bullous pemphigoid Uncommon Moderate
Eosinophilic cellulitis Uncommon Moderate to high High eosinophil count distinguishes from bacterial cause
Skin lymphoma (Sézary syn- Uncommon Moderate
drome: mycosis fungoides)
MISCELLANEOUS CAUSES
Interleukin (IL)-2 therapy Rare Moderate to high For renal cell carcinoma.
Hypereosinophilic syndrome Rare Moderate to high
Endomyocardial fibrosis Rare High Secondary to any cause of a high eosinophil count
Hyper-IgE syndrome Rare Moderate to high Possibly caused by fungal allergy
Eosinophilia/myalgia and Rare High Two related conditions, one caused by poisoning with con-
toxic oil syndrome Uncommon Mild to moderate taminated cooking oil in Spain and the other by a batch of
Graft-vs.-host disease Rare Mild tryptophan
DOCK8 (dedicator of cytoki- Rare May be caused by fungal allergy
nesis 8) deficiency Rare
Olmsted syndrome Rare
Kimura disease Uncommon
Angiolymphoid hyperplasia
Addison disease

The skin is one of the most commonly effected organs in HES with pru- been shown in vitro to be able to kill a number of opsonized parasites,
ritus being the commonest symptom, although ulceration also occurs. 143 including newborn larvae of Trichinella spiralis, larvae of Nippostrongylus
brasiliensis, a gut parasite in the rat, and larvae of Fasciola hepatica, as
well as shistosomulae of Schistosoma mansoni. In vivo, parasite larvae
EOSINOPHILS AND THE become opsonized with both specific IgG and IgE antibodies and com-
GASTROINTESTINAL TRACT ponents of the complement cascade such as C3bi, which can promote
adhesion and activation of eosinophils. Dead larvae of Schistosoma
Eosinophils are present in the normal gastrointestinal tract as a result of
constitutive expression of eotaxin and MAdCAM1 (mucosal addressin haematobium and other parasites have been detected in the skin sur-
cell adhesion molecule-1) the receptor for α β which is expressed by rounded by eosinophils and eosinophil granule products. Adult worms,
4 7
eosinophils. A number of diseases are associated with a gastrointestinal both in vitro and in vivo, appear resistant to eosinophil-mediated dam-
55
eosinophilia, including eosinophilic esophagitis, eosinophilic gastroen- age. Despite the circumstantial evidence of eosinophils being involved
teritis, and inflammatory bowel disease, although this latter condition in host defense against parasites, there remains doubt about their role.
does not result in a blood eosinophilia. Eosinophilic esophagitis is A number of experiments have been carried out in animal models of
144
an increasingly recognized condition in both children and adults. It is helminthic infection using IL-5 gene deletion, IL-5 transgenics, and
associated with food allergy often in the absence of specific IgE. It is anti–IL-5 antibodies to ablate the tissue eosinophilia. These studies have
another condition characterized by a marked tissue eosinophilia with- suggested that eosinophils may have a protective role in Strongyloides
out a marked blood eosinophil count. 145 and Filariasis but not in Schistosoma, Nippostrongylus, and Trichuris
infections. For example, treatment of mice infected with N. brasiliensis
or S. mansoni with neutralizing anti–IL-5 mAbs abolished the eosino-
EOSINOPHILS AND PARASITIC DISEASE philia without modulating the disease process. In contrast, using dif-
146
The role of eosinophils in parasitic disease is complex and still incom- fusion chambers eosinophils were conclusively shown to be involved
pletely understood. Table 62–5 and reference 146 summarize the in killing the larvae of Strongyloides stercoralis. In Trichinella spiralis
147
130
most common helminthic causes of an eosinophilia. Eosinophils have infections, eosinophils prolonged larval survival during the primary

Kaushansky_chapter 62_p0947-0964.indd 956 9/21/15 10:56 AM