Evaluation and Differential Diagnosis of Marked, Persistent Eosinophilia

Mejia, Rojelio; Nutman, Thomas B.

doi:10.1053/j.seminhematol.2012.01.006

Cited by 59 publications

(60 citation statements)

References 70 publications

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“…Elevated levels of serum periostin correlate with eosinophil levels and responsiveness to anti-IL-13, raising the possibility that this subgroup of patients should also be treated with anti-eosinophil therapy, either alone or in combination with anti-IL-13. Blood and tissue eosinophilia can occur in a wide variety of disease processes 162 and hypereosinophilic syndrome is a heterogeneous disorder that often has no identifiable cause 163 . Thus, it is necessary to identify sub-phenotypes of patients with eosinophilic disorders in order to predict treatment responses on the basis of a patient’s genetics or gene expression profiles of affected organs and to tailor therapy for their eosinophil-associated disease accordingly.…”

Section: Strategies For the Futurementioning

confidence: 99%

Targeting eosinophils in allergy, inflammation and beyond

Fulkerson

Rothenberg

2013

Nat Rev Drug Discov

419

338

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Eosinophils can regulate local immune and inflammatory responses, and their accumulation in the blood and tissue is associated with several inflammatory and infectious diseases. As such, therapies aimed at eosinophils may help control diverse diseases, including atopic disorders such as asthma and allergy, and diseases not primarily associated with eosinophils such as autoimmunity and malignancy. Recently, eosinophil-targeted therapeutic agents aimed at blocking specific steps involved in eosinophil development, migration and activation have entered clinical testing and have produced encouraging results and insights into the role of eosinophils. Herein, we describe recent advances in the development of first generation eosinophil-targeted therapies and highlight strategies for using personalized medicine approaches for eosinophilic disorders.

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Section: Strategies For the Futurementioning

confidence: 99%

Targeting eosinophils in allergy, inflammation and beyond

Fulkerson

Rothenberg

2013

Nat Rev Drug Discov

419

338

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“…Although a detailed discussion of the many and varied causes of secondary HE/HES is beyond the scope of this review and can be found in the published literature, 52,53 a few points deserve mention. First, a detailed medical history is paramount, as it can provide valuable clues to the underlying diagnosis.…”

Section: Associated Hesmentioning

confidence: 99%

How I treat hypereosinophilic syndromes

Klion

2015

Blood

208

126

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Hypereosinophilic syndromes (HESs) are a group of rare disorders characterized by peripheral blood eosinophilia of 1.5 × 109/L or higher and evidence of end organ manifestations attributable to the eosinophilia and not otherwise explained in the clinical setting. HESs are pleomorphic in clinical presentation and can be idiopathic or associated with a variety of underlying conditions, including allergic, rheumatologic, infectious, and neoplastic disorders. Moreover, the etiology of the eosinophilia in HESs can be primary (myeloid), secondary (lymphocyte-driven), or unknown. Although corticosteroids remain the first-line therapy for most forms of HESs, the availability of an increasing number of novel therapeutic agents, including tyrosine kinase inhibitors and monoclonal antibodies, has necessarily altered the approach to treatment of HESs. This review presents an updated treatment-based approach to the classification of patients with presumed HES and discusses the roles of conventional and novel agents in the management of these patients.

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“…Among antimicrobials, asymptomatic eosinophilia has most commonly been described with penicillins, cephalosporins, and flouroquinolones (1, 21). However, these same classes of antibiotics are also implicated in HSRs (10, 22, 23).…”

Section: Introductionmentioning

confidence: 99%

Peripheral blood eosinophilia and hypersensitivity reactions among patients receiving outpatient parenteral antibiotics

Blumenthal

Youngster

Rabideau

et al. 2015

Journal of Allergy and Clinical Immunology

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Background While drug-induced peripheral eosinophilia complicates antimicrobial therapy, little is known about its frequency and implications. Objective We aimed to determine the frequency and predictors of antibiotic-induced eosinophilia and subsequent hypersensitivity reactions (HSRs). Methods We evaluated a prospective cohort of former inpatients receiving intravenous antibiotic therapy as outpatients with at least one differential blood count. We used multivariate Cox proportional hazards models, with time-varying antibiotic treatment indicators, to assess the impact of demographic data and antibiotic exposures on eosinophilia and subsequent HSR, including documented rash, renal injury, and liver injury. Possible Drug Rash Eosinophilia and Systemic Symptoms (DRESS) syndrome cases were identified and manually validated. Results Of 824 patients (60% male, median age 60 years, median therapy duration 41 days), 210 (25%) developed eosinophilia with median peak absolute eosinophil count of 726/mL [IQR: 594–990/mL]. Use of vancomycin, penicillin, rifampin, and linezolid were associated with a higher hazard of developing eosinophilia. There was subsequent HSR in 64/210 (30%) patients with eosinophilia, including rash (N=32), renal injury (N=31), and liver injury (N=13). Patients with eosinophilia were significantly more likely to develop rash (HR = 4.16 [2.54, 6.83]; p<0.0001) and renal injury (HR = 2.13 [1.36, 3.33]; p=0.0009), but not liver injury (HR = 1.75 [0.92, 3.33]; p=0.09). Possible DRESS syndrome occurred in 7/824 (0.8%) patients; 4 (57%) were on vancomycin. Conclusions Drug-induced eosinophilia is common with parenteral antibiotics. While most patients with eosinophilia do not develop an HSR, eosinophilia increases the hazard rate of developing rash and renal injury. DRESS syndrome was more common than previously described.

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Evaluation and Differential Diagnosis of Marked, Persistent Eosinophilia

Cited by 59 publications

References 70 publications

Targeting eosinophils in allergy, inflammation and beyond

Targeting eosinophils in allergy, inflammation and beyond

How I treat hypereosinophilic syndromes

Peripheral blood eosinophilia and hypersensitivity reactions among patients receiving outpatient parenteral antibiotics

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