Page 380 - Clinical Immunology_ Principles and Practice ( PDFDrive )

360 Part two Host Defense Mechanisms and Inflammation

eosinophil granule protein levels (in urine, BAL fluids, and blood, sputum, or tissue examinations, as well as results of
24
involved allograft tissues) have correlated with prognosis, severity, serological tests. The duration and magnitude of the eosinophilia
and response to rejection therapy. may suggest some entities, especially if it is prolonged or markedly
elevated (see Table 24.1). Other causes of eosinophilia that are
Endocrine Diseases amenable to treatment include eosinophilia secondary to medica-
The loss of endogenous adrenoglucocorticosteroid production tions, for which cessation of the offending drug may be indicated
in Addison disease, adrenal hemorrhage, or hypopituitarism can if the eosinophilia is accompanied by organ damage. Likewise,
cause increased blood eosinophilia, although usually not more if eosinophilia is secondary to glucocorticosteroid deficiency,
than mild to moderate. diagnostic testing can corroborate this deficiency and lead to
the administration of replacement corticosteroids and consequent
Other Causes of Eosinophilia resolution of the eosinophilia.
The syndrome of atheromatous cholesterol embolization is at Because allergic diseases usually are associated with at least
times associated with hypocomplementemia, eosinophilia, and some degree of eosinophilia, clinical and laboratory evidence of
eosinophiluria. Rarely, cases of hereditary eosinophilia among such disease should be sought. If the eosinophilia is not attribut-
family members have been recognized. Irritation of serosal surfaces able to allergic diseases, parasitic infections, medications, or
can be associated with eosinophilia, and related diseases can steroid deficiency, further evaluation will be guided by whether
include Dressler syndrome; eosinophilic pleural effusions; the patient has evidence of organ disease and, if so, which organs
peritoneal and, at times, blood eosinophilia developing during are involved (see Table 24.2). This is germane, for instance, in
chronic peritoneal dialysis; and perhaps the eosinophilia that defining whether the patient has a distinct eosinophilic pulmonary,
follows abdominal irradiation. GI, or cutaneous syndrome. Bone marrow examinations in most
patients with eosinophilia are not usually informative, revealing
only evidence of enhanced eosinophilopoiesis; but bone marrow
should be examined if there is suspicion of a hematological
tHEraPEUtIC PrINCIPLES malignancy or myeloproliferative disorder. For patients with
Therapy of Specific Eosinophilic Diseases sustained eosinophilia who meet the criteria for HES, diagnostic
testing should aim to identify which variant form of HES the
Eosinophil-associated Diseases with Identifiable Etiologies patient may have, in which case, bone marrow examination is
Parasitic infections Treat causative parasite often needed (see Fig. 24.4).
Drug-reaction related Terminate eliciting medication
eosinophilias oN tHE HorIZoN
Adrenal insufficiency Corticosteroid replacement therapy
Allergic/atopic diseases Varied, may include topical or inhaled Identify the causes of those hypereosinophilic syndromes for which
corticosteroids etiologies currently remain unknown.
Delineation of the signaling mechanisms that govern the agonist-specific,
Distinct Eosinophilic Syndromes Involving Specific organs differential secretion of cytokines that are preformed and stored within
Eosinophilic pulmonary diseases: eosinophil granules and secretory vesicles.
Acute eosinophilic pneumonia Corticosteroids Continue to evaluate the therapeutic efficacies of anticytokine therapeutics,
Chronic eosinophilic pneumonia Corticosteroids, interferon-α including anti–interleukin (IL)-5 neutralizing antibodies, in the treatment
Eosinophilic granulomatosis with Corticosteroids, interferon-α of the varied forms of eosinophilic diseases.
polyangiitis Identify biomarkers that are predictive of eosinophil-mediated tissue
damage and that can be used for clinical diagnostic and therapeutic
Hypereosinophilic Syndromes monitoring tools.
F/P-positive myeloproliferative Imatinib
Lymphoproliferative and other Corticosteroids, interferon-α,
hydroxyurea, anti–interleukin (IL)-5 Please check your eBook at https://expertconsult.inkling.com/
monoclonal antibody (mAb), other for self-assessment questions. See inside cover for registration
details.

REFERENCES
EVALUATION OF EOSINOPHILIA
1. Blanchard C, Rothenberg ME. Biology of the eosinophil. Adv Immunol
Because a diversity of disorders can be accompanied by eosino- 2009;101:81–121.
philia, evaluation of the patient with eosinophilia requires a 2. Rosenberg HF, Dyer KD, Foster PS. Eosinophils: changing perspectives in
consideration of features based on the patient’s history, physical health and disease. Nat Rev Immunol 2013;13:9–22.
examination, and other laboratory, radiographic, or diagnostic 3. Spencer LA, Weller PF. Eosinophils and Th2 immunity: contemporary
tests. 26,36,37 An initial approach can focus on identifying eosino- insights. Immunol Cell Biol 2010;88:250–6.
philic diseases that have a defined treatable etiology. These include 4. Shamri R, Xenakis JJ, Spencer LA. Eosinophils in innate immunity: an
infections with helminth parasites, and for these, the approach evolving story. Cell Tissue Res 2011;343:57–83.
should be guided by information obtained from patient history 5. Nussbaum JC, Van Dyken SJ, von Moltke J, et al. Type 2 innate lymphoid
cells control eosinophil homeostasis. Nature 2013;502:245–8.
about potential exposures; results of the history and physical 6. Bochner BS. Siglec-8 on human eosinophils and mast cells, and Siglec-F
examinations with regard to signs and symptoms of any clinically on murine eosinophils, are functionally related inhibitory receptors.
apparent associated illness; results of standard biochemical and Clin Exp Allergy 2009;39:317–24.
radiographic tests for evidence of organ involvement; and results 7. Bozza PT, Magalhaes KG, Weller PF. Leukocyte lipid bodies—biogenesis
of specific parasitological tests, including potentially stool, urine, and functions in inflammation. Biochim Biophys Acta 2009;1791:540–51.