Significance of eosinophilia during gold therapy

Abstract

Adverse clinical reactions (predominantly skin rashes) were seen in 14 of 50 patients receiving gold therapy for rheumatoid arthritis. In 11 of the 14 eosinophilia either accompanied or preceded the reaction. A further 9 patients who received gold developed eosinophilia alone. IgE levels were increased in 17 of the 20 patients with eosinophilia but were normal in 24 of 27 patients who received gold without apparent adverse effects. In only 1 patient on gold was a skin rash not accompanied by either eosinophilia or a raised IgE level. All eosinophil counts and IgE levels fell to normal after therapy was discontinued. It is suggested that eosinophilia may be the most common side effect of gold therapy and provides a useful guide for monitoring patients receiving gold salts. The strong association with raised IgE levels suggests that type 1 hypersensitivity may be the mechanism of these reactions.

Gold Sodium Thiomalate (GTM) Induces Hypersensitivity to Thiomalate, the Thiol Carrier of GTM

“…The authors of these reports have supposed that delayed type hypersensitivity (DTH) might be involved in the genesis of adverse skin reactions to GTM. Another immunological mechanism has also been suggested because increases in IgE and eosinophilia are often seen in gold dermatitis (11). Recently it has been reported that there is a strong correlation between HLA-DR3 and GTM-induced adverse reactions in RA patients treated with GTM (9).…”

Pulmonary toxicity with gold therapy

“…Eosinophilia has been seen at times in rheumatoid arthritis (13,18), especially in association with vasculitis, nodules, pleuropericarditis, and pulmonary fibrosis. It has been estimated to occur in 5% to 40% of cases treated with gold but is often transient (1,14). In one study (14) patients receiving gold who developed eosinophilia had a higher incidence of developing other side effects (55%) than those without eosinophilia (1 1%).…”

“…It has been estimated to occur in 5% to 40% of cases treated with gold but is often transient (1,14). In one study (14) patients receiving gold who developed eosinophilia had a higher incidence of developing other side effects (55%) than those without eosinophilia (1 1%). The five cited cases with eosinophilia also fulfill the criteria for PIE (pulmonary infiltration with eosinophilia) syndrome.…”

Treatment of Pemphigus With Gold

“…While pemphigus itself may cause eosinophilia, an increase in eosinophils during gold therapy has been reported to herald other complications and should lead to withholding the use of gold until it resolves. 13 Cutaneous adverse effects, such as pruritus and drug eruptions, are common, as are proteinuria and nitritoid reactions. 14 Gold therapy has been restarted after minor toxic effects such as dermatitis and mild proteinuria resolve, without a recurrence of adverse effects.…”