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CHARACTERIZATION OF CONSULTATIONS REQUESTED FOR PATIENTS WITH ELEVATED BLOOD EOSINOPHILS: A TERTIARY IMMUNOLOGY AND ALLERGY CLINIC EXPERIENCE

Year 2022, Volume: 85 Issue: 3, 370 - 377, 06.07.2022
https://doi.org/10.26650/IUITFD.1068715

Abstract

Objective: Blood eosinophilia has become a common labora-tory abnormality and its characterization poses a dilemma for physicians. As a result, physicians often consult specialists in immunology and allergy in order to evaluate patients with high eosinophils, with the general assumption of an underlying aller-gic or immunologic cause. However, there is little data in the literature regarding consultations requested from immunology and allergy clinics because of eosinophilia. This study aimed to evaluate the clinical and demographic characteristics of patients who were consulted to the allergy clinic because of eosinophilia and detail the etiologies of eosinophilia.Methods: The medical records of 1366 patients consulted to the allergy clinic were evaluated retrospectively, and the data of 143 patients who were consulted for eosinophilia were investigated.Results: The median (range) eosinophil count was 2456 cells/mm3 (520-42920). 86 (60.1%) patients were classified as mild (500 to 1500 cells/mm3), 44 (30.8%) patients as moderate (1500 to 5000 cells/mm3), and 13 (9.1%) patients as severe (≥5000 cells/mm3) eosinophilia. The most frequently consulted departments were chest diseases (37.1%), internal medicine (34.2%), and dermatology (14.7%), respectively. While the most common clinical symptoms at presentation were cough, dyspnea, pruritus, rhinitis, and gastrointestinal symptoms, 49 (34.3%) patients were asymptomatic. The mean±SD vitamin B12 and tryptase levels were 424.2±240.5 pg/mL, and 4.48±1.76 ng/mL, respectively. The median total IgE level was 150 IU/mL (1.5-9464). Atopy was identified in 26.6% (n=38) of the patients. Among 143 eosinophilia patients, there were no patients diagnosed with myeloproliferative or lymphocytic variants of hypereosinophilic syndrome (HES), eight patients were diagnosed with idiopathic HES. While the most common underlying causes were asthma (n=38) and allergic rhinitis (n=20), 30 patients had non-allergic causes.Conclusion: Although parasitic infections and allergic diseases are the first etiologies that come to mind when eosinophilia is detected in a patient, a specific anamnesis and advanced di-agnostic tests for differential should be performed in order to detect other underlying or accompanying conditions apart from these diseases.

References

  • 1. Renz H, Bachert C, Berek C, Hamelmann E, Levi-Schaffer F, Raap U, et al. Physiology and pathology of eosinophils: Recent developments: Summary of the Focus Workshop Organized by DGAKI. Scand J Immunol 2021;93(6):e13032. [CrossRef] google scholar
  • 2. Wechsler ME, Munitz A, Ackerman SJ, Drake MG, Jackson DJ, Wardlaw AJ, et al. Eosinophils in Health and Disease: A State-of-the-Art Review. Mayo Clin Proc 2021;96(10):2694- 707. [CrossRef] google scholar
  • 3. Ramirez GA, Yacoub MR, Ripa M, Mannina D, Cariddi A, Saporiti N, et al. Eosinophils from Physiology to Disease: A Comprehensive Review. Biomed Res Int 2018;2018:9095275. [CrossRef] google scholar
  • 4. Lee JJ, Jacobsen EA, McGarry MP, Schleimer RP, Lee NA. Eosinophils in health and disease: the LIAR hypothesis. Clin Exp Allergy 2010;40(4):563-75. [CrossRef] google scholar
  • 5. Shomali W, Gotlib J. World Health Organization-defined eosinophilic disorders: 2022 update on diagnosis, risk stratification, and management. Am J Hematol 2022;97(1):129-48. [CrossRef] google scholar
  • 6. Moller D, Tan J, Gauiran DTV, Medvedev N, Hudoba M, Carruthers MN, et al. Causes of hypereosinophilia in 100 consecutive patients. Eur J Haematol 2020;105(3):292-301. [CrossRef] google scholar
  • 7. Williams KW, Ware J, Abiodun A, Holland-Thomas NC, Khoury P, Klion AD. Hypereosinophilia in children and adults: a retrospective comparison. J Allergy Clin Immunol Pract 2016;4(5):941-7.e1. [CrossRef] google scholar
  • 8. Peju M, Deroux A, Pelloux H, Bouillet L, Epaulard O. Hypereosinophilia: Biological investigations and etiologies in a French metropolitan university hospital, and proposed approach for diagnostic evaluation. PLoS One 2018;13(9):e0204468. [CrossRef] google scholar
  • 9. O’Connell EM, Nutman TB. Eosinophilia in infectious diseases. Immunol Allergy Clin North Am 2015;35(3):493-522. [CrossRef] google scholar
  • 10. Schwartz JT, Fulkerson PC. An approach to the evaluation of persistent hypereosinophilia in pediatric patients. Front Immunol 2018;9:1944. [CrossRef] google scholar
  • 11. Tefferi A, Patnaik MM, Pardanani A. Eosinophilia: secondary, clonal and idiopathic. Br J Haematol 2006;133(5):468-92. [CrossRef] google scholar
  • 12. Chanswangphuwana C, Uaprasert N, Moonla C, Rojnuckarin P. Causes and outcomes of hypereosinophilia in a tropical country. Asian Pac J Allergy Immunol 2021. [CrossRef] google scholar
  • 13. McGovern TW, Talley NJ, Kephart GM, Carpenter HA, Gleich GJ. Eosinophil infiltration and degranulation in Helicobacter pylori-associated chronic gastritis. Dig Dis Sci 1991;36(4):435-40. [CrossRef] google scholar
  • 14. Aydemir SA, Tekin IO, Numanoglu G, Borazan A, Ustundag Y. Eosinophil infiltration, gastric juice and serum eosinophil cationic protein levels in Helicobacter pylori-associated chronic gastritis and gastric ulcer. Mediators Inflamm 2004;13(5-6):369-72. [CrossRef] google scholar
  • 15. Arnold IC, Artola-Boran M, Tallon de Lara P, Kyburz A, Taube C, Ottemann K, et al. Eosinophils suppress Th1 responses and restrict bacterially induced gastrointestinal inflammation. J Exp Med 2018;215(8):2055-72. [CrossRef] google scholar
  • 16. Hartl S, Breyer MK, Burghuber OC, Ofenheimer A, Schrott A, Urban MH, et al. Blood eosinophil count in the general population: typical values and potential confounders. Eur Respir J 2020;55(5):1901874. [CrossRef] google scholar
  • 17. Rosenberg CE, Khoury P. Approach to eosinophilia presenting with pulmonary symptoms. Chest 2021;159(2):507-16. [CrossRef] google scholar
  • 18. Bernheim A, McLoud T. A Review of Clinical and Imaging Findings in Eosinophilic Lung Diseases. AJR Am J Roentgenol 2017;208(5):1002-10. [CrossRef] google scholar
  • 19. Khoury P, Bochner BS. Consultation for Elevated Blood Eosinophils: Clinical Presentations, High Value Diagnostic Tests, and Treatment Options. J Allergy Clin Immunol Pract 2018;6(5):1446-53. [CrossRef] google scholar
  • 20. Blumenthal KG, Youngster I, Rabideau DJ, Parker RA, Manning KS, Walensky RP, et al. Peripheral blood eosinophilia and hypersensitivity reactions among patients receiving outpatient parenteral antibiotics. J Allergy Clin Immunol 2015;136(5):1288-94.e1. [CrossRef] google scholar
  • 21. Burris D, Rosenberg CE, Schwartz JT, Zhang Y, Eby MD, Abonia JP, et al. Pediatric Hypereosinophilia: Characteristics, Clinical Manifestations, and Diagnoses. J Allergy Clin Immunol Pract 2019;7(8):2750-8.e2. [CrossRef] google scholar
  • 22. Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: estimates from a national administrative database. J Pediatr Gastroenterol Nutr 2016;62(1):36-42. [CrossRef] google scholar
  • 23. Gonsalves N. Eosinophilic Gastrointestinal Disorders. Clin Rev Allergy Immunol 2019;57(2):272-85. [CrossRef] google scholar
  • 24. Dellon ES, Jensen ET, Martin CF, Shaheen NJ, Kappelman MD. Prevalence of eosinophilic esophagitis in the United States. Clin Gastroenterol Hepatol 2014;12(4):589-96 e1. [CrossRef] google scholar
  • 25. Bjerrum OW, Siersma V, Hasselbalch HC, Lind B, Andersen CL. Association of the blood eosinophil count with end-organ symptoms. Ann Med Surg (Lond) 2019;45:11-8. [CrossRef] google scholar

YÜKSEK KAN EOZİNOFİL SAYISI NEDENİYLE TALEP EDİLEN KONSULTASYONLARIN KARAKTERİZASYONU: ÜÇÜNCÜ BASAMAK BİR İMMUNOLOJİ VE ALERJİ KLİNİĞİ DENEYİMİ

Year 2022, Volume: 85 Issue: 3, 370 - 377, 06.07.2022
https://doi.org/10.26650/IUITFD.1068715

Abstract

Amaç: Tam kan sayımı ölçümlerinin yaygın olarak kullanılmaya başlanmasıyla eozinofil yüksekliği sık görülen bir laboratuvar anormalliği haline gelmiştir. Tanısal değerlendirmesi hekimler için zorluk teşkil eden eozinofili, genellikle altta yatan bir alerjik veya immünolojik hastalık varlığı genel varsayımı ile immünoloji ve alerji uzmanlarına sık konsülte edilmektedir. Ancak eozinofili nedeniyle immünoloji ve alerji kliniklerinden istenen konsültas-yonların değerlendirmelerine ilişkin literatürde çok az bilgi vardır. Bu çalışmada eozinofili nedeniyle alerji kliniğine yönlendirilen hastaların klinik ve demografik özelliklerinin değerlendirilmesi ve eozinofili etiyolojilerinin detaylandırılması amaçlanmıştır.Yöntem: Bir yıllık süre içinde immünoloji ve alerji kliniğimize konsülte edilen 1366 hastanın tıbbi kayıtları geriye dönük olarak tarandı.Sonuçlar: Hastaların medyan (aralık) eozinofil sayısı 2456 hücre/mm3 (520-42920) idi. Eozinofil yüksekliklerine göre sınıflandırıl-dıklarında; 86 (%60,1) hasta hafif (500 ila 1500 hücre/mm3), 44 (%30,8) hasta orta (1500 ila 5000 hücre/mm3) ve 13 (%9,1) has-ta şiddetli (≥5000 hücre/mm3) eozinofili olarak sınıflandırıldı. En sık konsültasyon isteyen bölümler sırasıyla göğüs hastalıkları (%37,1), iç hastalıkları (%34,2) ve dermatoloji (%14,7) idi. Başvuru anında en sık görülen klinik semptomlar öksürük, nefes darlığı, kaşıntı, rinit ve gastrointestinal semptomlar iken, 49 (%34,3) has-ta asemptomatikti. Ortalama±SD vitamin B12 ve triptaz seviye-leri sırasıyla 424.2±240,5 pg/mL ve 4.48±1.76 ng/mL idi. Medyan total IgE seviyesi 150 IU/mL (1.5-9464) idi. Hastaların %26,6’sında (n=38) atopi tespit edildi. 143 eozinofili hastası arasında hipe-reozinofilik sendrom (HES)’in miyeloproliferatif veya lenfositik varyantları tanısı konan hiçbir hasta yoktu, sekiz hastaya idiyopa-tik HES tanısı kondu. En sık altta yatan eozinofili nedenleri astım (n=38) ve alerjik rinit (n=20) iken, 30 hastada altta yatan nedenler alerjik değildi.Tartışma: Bir hastada eozinofili saptandığında akla ilk gelen eti-yolojiler paraziter enfeksiyonlar ve alerjik hastalıklar olsa da, bu hastalıklar dışında altta yatan veya eşlik eden diğer durumların saptanması için detaylı bir anamnez ve ayırıcı tanı için ileri tanı testleri yapılmalıdır.

References

  • 1. Renz H, Bachert C, Berek C, Hamelmann E, Levi-Schaffer F, Raap U, et al. Physiology and pathology of eosinophils: Recent developments: Summary of the Focus Workshop Organized by DGAKI. Scand J Immunol 2021;93(6):e13032. [CrossRef] google scholar
  • 2. Wechsler ME, Munitz A, Ackerman SJ, Drake MG, Jackson DJ, Wardlaw AJ, et al. Eosinophils in Health and Disease: A State-of-the-Art Review. Mayo Clin Proc 2021;96(10):2694- 707. [CrossRef] google scholar
  • 3. Ramirez GA, Yacoub MR, Ripa M, Mannina D, Cariddi A, Saporiti N, et al. Eosinophils from Physiology to Disease: A Comprehensive Review. Biomed Res Int 2018;2018:9095275. [CrossRef] google scholar
  • 4. Lee JJ, Jacobsen EA, McGarry MP, Schleimer RP, Lee NA. Eosinophils in health and disease: the LIAR hypothesis. Clin Exp Allergy 2010;40(4):563-75. [CrossRef] google scholar
  • 5. Shomali W, Gotlib J. World Health Organization-defined eosinophilic disorders: 2022 update on diagnosis, risk stratification, and management. Am J Hematol 2022;97(1):129-48. [CrossRef] google scholar
  • 6. Moller D, Tan J, Gauiran DTV, Medvedev N, Hudoba M, Carruthers MN, et al. Causes of hypereosinophilia in 100 consecutive patients. Eur J Haematol 2020;105(3):292-301. [CrossRef] google scholar
  • 7. Williams KW, Ware J, Abiodun A, Holland-Thomas NC, Khoury P, Klion AD. Hypereosinophilia in children and adults: a retrospective comparison. J Allergy Clin Immunol Pract 2016;4(5):941-7.e1. [CrossRef] google scholar
  • 8. Peju M, Deroux A, Pelloux H, Bouillet L, Epaulard O. Hypereosinophilia: Biological investigations and etiologies in a French metropolitan university hospital, and proposed approach for diagnostic evaluation. PLoS One 2018;13(9):e0204468. [CrossRef] google scholar
  • 9. O’Connell EM, Nutman TB. Eosinophilia in infectious diseases. Immunol Allergy Clin North Am 2015;35(3):493-522. [CrossRef] google scholar
  • 10. Schwartz JT, Fulkerson PC. An approach to the evaluation of persistent hypereosinophilia in pediatric patients. Front Immunol 2018;9:1944. [CrossRef] google scholar
  • 11. Tefferi A, Patnaik MM, Pardanani A. Eosinophilia: secondary, clonal and idiopathic. Br J Haematol 2006;133(5):468-92. [CrossRef] google scholar
  • 12. Chanswangphuwana C, Uaprasert N, Moonla C, Rojnuckarin P. Causes and outcomes of hypereosinophilia in a tropical country. Asian Pac J Allergy Immunol 2021. [CrossRef] google scholar
  • 13. McGovern TW, Talley NJ, Kephart GM, Carpenter HA, Gleich GJ. Eosinophil infiltration and degranulation in Helicobacter pylori-associated chronic gastritis. Dig Dis Sci 1991;36(4):435-40. [CrossRef] google scholar
  • 14. Aydemir SA, Tekin IO, Numanoglu G, Borazan A, Ustundag Y. Eosinophil infiltration, gastric juice and serum eosinophil cationic protein levels in Helicobacter pylori-associated chronic gastritis and gastric ulcer. Mediators Inflamm 2004;13(5-6):369-72. [CrossRef] google scholar
  • 15. Arnold IC, Artola-Boran M, Tallon de Lara P, Kyburz A, Taube C, Ottemann K, et al. Eosinophils suppress Th1 responses and restrict bacterially induced gastrointestinal inflammation. J Exp Med 2018;215(8):2055-72. [CrossRef] google scholar
  • 16. Hartl S, Breyer MK, Burghuber OC, Ofenheimer A, Schrott A, Urban MH, et al. Blood eosinophil count in the general population: typical values and potential confounders. Eur Respir J 2020;55(5):1901874. [CrossRef] google scholar
  • 17. Rosenberg CE, Khoury P. Approach to eosinophilia presenting with pulmonary symptoms. Chest 2021;159(2):507-16. [CrossRef] google scholar
  • 18. Bernheim A, McLoud T. A Review of Clinical and Imaging Findings in Eosinophilic Lung Diseases. AJR Am J Roentgenol 2017;208(5):1002-10. [CrossRef] google scholar
  • 19. Khoury P, Bochner BS. Consultation for Elevated Blood Eosinophils: Clinical Presentations, High Value Diagnostic Tests, and Treatment Options. J Allergy Clin Immunol Pract 2018;6(5):1446-53. [CrossRef] google scholar
  • 20. Blumenthal KG, Youngster I, Rabideau DJ, Parker RA, Manning KS, Walensky RP, et al. Peripheral blood eosinophilia and hypersensitivity reactions among patients receiving outpatient parenteral antibiotics. J Allergy Clin Immunol 2015;136(5):1288-94.e1. [CrossRef] google scholar
  • 21. Burris D, Rosenberg CE, Schwartz JT, Zhang Y, Eby MD, Abonia JP, et al. Pediatric Hypereosinophilia: Characteristics, Clinical Manifestations, and Diagnoses. J Allergy Clin Immunol Pract 2019;7(8):2750-8.e2. [CrossRef] google scholar
  • 22. Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: estimates from a national administrative database. J Pediatr Gastroenterol Nutr 2016;62(1):36-42. [CrossRef] google scholar
  • 23. Gonsalves N. Eosinophilic Gastrointestinal Disorders. Clin Rev Allergy Immunol 2019;57(2):272-85. [CrossRef] google scholar
  • 24. Dellon ES, Jensen ET, Martin CF, Shaheen NJ, Kappelman MD. Prevalence of eosinophilic esophagitis in the United States. Clin Gastroenterol Hepatol 2014;12(4):589-96 e1. [CrossRef] google scholar
  • 25. Bjerrum OW, Siersma V, Hasselbalch HC, Lind B, Andersen CL. Association of the blood eosinophil count with end-organ symptoms. Ann Med Surg (Lond) 2019;45:11-8. [CrossRef] google scholar
There are 25 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section RESEARCH
Authors

Şengül Beyaz 0000-0002-1505-4293

Zeynep Çelebi Sozener 0000-0002-5896-262X

Şadan Soyyiğit This is me 0000-0003-3270-5884

Publication Date July 6, 2022
Submission Date February 7, 2022
Published in Issue Year 2022 Volume: 85 Issue: 3

Cite

APA Beyaz, Ş., Çelebi Sozener, Z., & Soyyiğit, Ş. (2022). CHARACTERIZATION OF CONSULTATIONS REQUESTED FOR PATIENTS WITH ELEVATED BLOOD EOSINOPHILS: A TERTIARY IMMUNOLOGY AND ALLERGY CLINIC EXPERIENCE. Journal of Istanbul Faculty of Medicine, 85(3), 370-377. https://doi.org/10.26650/IUITFD.1068715
AMA Beyaz Ş, Çelebi Sozener Z, Soyyiğit Ş. CHARACTERIZATION OF CONSULTATIONS REQUESTED FOR PATIENTS WITH ELEVATED BLOOD EOSINOPHILS: A TERTIARY IMMUNOLOGY AND ALLERGY CLINIC EXPERIENCE. İst Tıp Fak Derg. July 2022;85(3):370-377. doi:10.26650/IUITFD.1068715
Chicago Beyaz, Şengül, Zeynep Çelebi Sozener, and Şadan Soyyiğit. “CHARACTERIZATION OF CONSULTATIONS REQUESTED FOR PATIENTS WITH ELEVATED BLOOD EOSINOPHILS: A TERTIARY IMMUNOLOGY AND ALLERGY CLINIC EXPERIENCE”. Journal of Istanbul Faculty of Medicine 85, no. 3 (July 2022): 370-77. https://doi.org/10.26650/IUITFD.1068715.
EndNote Beyaz Ş, Çelebi Sozener Z, Soyyiğit Ş (July 1, 2022) CHARACTERIZATION OF CONSULTATIONS REQUESTED FOR PATIENTS WITH ELEVATED BLOOD EOSINOPHILS: A TERTIARY IMMUNOLOGY AND ALLERGY CLINIC EXPERIENCE. Journal of Istanbul Faculty of Medicine 85 3 370–377.
IEEE Ş. Beyaz, Z. Çelebi Sozener, and Ş. Soyyiğit, “CHARACTERIZATION OF CONSULTATIONS REQUESTED FOR PATIENTS WITH ELEVATED BLOOD EOSINOPHILS: A TERTIARY IMMUNOLOGY AND ALLERGY CLINIC EXPERIENCE”, İst Tıp Fak Derg, vol. 85, no. 3, pp. 370–377, 2022, doi: 10.26650/IUITFD.1068715.
ISNAD Beyaz, Şengül et al. “CHARACTERIZATION OF CONSULTATIONS REQUESTED FOR PATIENTS WITH ELEVATED BLOOD EOSINOPHILS: A TERTIARY IMMUNOLOGY AND ALLERGY CLINIC EXPERIENCE”. Journal of Istanbul Faculty of Medicine 85/3 (July 2022), 370-377. https://doi.org/10.26650/IUITFD.1068715.
JAMA Beyaz Ş, Çelebi Sozener Z, Soyyiğit Ş. CHARACTERIZATION OF CONSULTATIONS REQUESTED FOR PATIENTS WITH ELEVATED BLOOD EOSINOPHILS: A TERTIARY IMMUNOLOGY AND ALLERGY CLINIC EXPERIENCE. İst Tıp Fak Derg. 2022;85:370–377.
MLA Beyaz, Şengül et al. “CHARACTERIZATION OF CONSULTATIONS REQUESTED FOR PATIENTS WITH ELEVATED BLOOD EOSINOPHILS: A TERTIARY IMMUNOLOGY AND ALLERGY CLINIC EXPERIENCE”. Journal of Istanbul Faculty of Medicine, vol. 85, no. 3, 2022, pp. 370-7, doi:10.26650/IUITFD.1068715.
Vancouver Beyaz Ş, Çelebi Sozener Z, Soyyiğit Ş. CHARACTERIZATION OF CONSULTATIONS REQUESTED FOR PATIENTS WITH ELEVATED BLOOD EOSINOPHILS: A TERTIARY IMMUNOLOGY AND ALLERGY CLINIC EXPERIENCE. İst Tıp Fak Derg. 2022;85(3):370-7.

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