EOZİNOFİLİ SAPTANAN ÇOCUK VAKALARDA ETİYOLOJİK FAKTÖRLERİN DEĞERLENDİRİLMESİ

Abstract

Amaç: Eozinofili dokularda ve/veya kanda eozinofillerin artması olarak tanımlanır. Periferik kanda eozinofil sayısının artması alerjik, enfeksiyöz, otoimmün ve malign hastalıkların ayırıcı bir özelliği ya da eşlik eden bulgusu olabilir. Çalışmamızda eozinofilisi olan çocuk hastaların etiyolojik faktörler açısından taranması amaçlanmıştır. Gereç ve Yöntemler: Kırıkkale Üniversitesi Tıp Fakültesi Çocuk Alerji ve İmmünoloji Polikliniğine Şubat 2020-Kasım 2021 tarihleri arasında başvuran ve tam kan sayımında eozinofili saptanan 1 ay-18 yaş arasındaki tüm hastaların elektronik dosyaları geriye dönük olarak incelendi. Tam kan sayımı ölçümünde periferik kan mutlak eozinofil sayısı ≥500 hücre/μL olması eozinofili olarak kabul edildi. Hastaların demografik verileri, klinik bulguları ve tetkik sonuçları retrospektif olarak değerlendirildi. Bulgular: Çalışmaya dahil edilen 176 hastanın 104’ü (%59.1) erkek olup, ortanca yaş 4.1 (0.6-8.9) [ortanca (çeyrekler arası aralık)] yıl idi. Hastaların 68’inde (%38.6) alerjik rinit, 51’inde (%28.9) atopik dermatit, 44’ünde (%25.0) astım ve 41’inde (%23.2) besin alerjisi vardı. Deri prik testi yapılan 113 hastanın 72’sinde (%63.7) alerjik duyarlanma saptandı. Alerjik duyarlanma saptanan hastalarda en sık polen (%43.0) ve besin duyarlılığı (%45.8) olduğu görüldü. Laboratuvar tetkiklerinde ortanca eozinofil sayısı 720/μL (580-1050), total IgE düzeyi 99.0 IU/mL (20.8-272) saptandı. Hastaların 25’inde (%14.2) en az bir immünglobülin düzeyinde düşüklük saptandı. Üç hastada (%1.7) paraziter hastalık mevcuttu. Sonuç: Alerjik hastalıklar eozinofilinin önemli nedeni olmakla birlikte paraziter hastalıklar, immün yetmezlikler gibi altta yatan birçok hastalıkta eozinofili görülebilir. Kapsamlı öykü ve klinik değerlendirme ayırıcı tanıda önemlidir.

Keywords

• Alerjik hastalık
• çocuk
• eozinofili
• parazit
• periferik kan

Evaluation of Etiological Factors in Pediatric Cases with Eosinophilia

Abstract

Objective: Eosinophilia is an increase in eosinophils in tissues and/or blood. Increased number of eosinophils in peripheral blood may be a differential feature or an accompanying finding of allergic, infectious, autoimmune, and malignant diseases. In our study, we aimed to screen pediatric patients with eosinophilia in terms of etiological factors. Material and Methods: The electronic files of all patients between the ages of 1 month and 18 years who were admitted to Kırıkkale University Faculty of Medicine, Pediatric Allergy and Immunology Outpatient Clinic between February 2020 and November 2021 and who were found to have eosinophilia in complete blood count were retrospectively analysed. A peripheral blood absolute eosinophil count of ≥500 cells/μL in the complete blood count measurement was considered eosinophilia. Demographic data, clinical findings and results of investigations were analysed retrospectively. Results: Of the 176 patients included in the study, 104 (59.1%) were male and the median age was 4.1 (0.6-8.9) [median (interquartile range)] years. Allergic rhinitis was present in 68 (38.6%), atopic dermatitis in 51 (28.9%), asthma in 44 (25.0%) and food allergy in 41 (23.2%) patients. Allergic sensitization was detected in 72 (63.7%) of 113 patients who underwent skin prick testing. The most common allergic sensitisation was pollen (43.0%) and food sensitisation (45.8%). The median eosinophil count was 720/μL (580-1050) and the total IgE level was 99.0 IU/mL (20.8-272). Low levels of at least one immunoglobulin were found in 25 patients (14.2%). Three patients (1.7%) had parasitic disease. Conclusion: Although allergic diseases are important causes of eosinophilia, eosinophilia can be seen in many underlying diseases such as parasitic diseases and immunodeficiencies. Comprehensive history and clinical evaluation are important in the differential diagnosis.

Keywords

• Allergic disease
• child
• eosinophilia
• parasite
• peripheral blood

References

1. Kovalszki A, Sheikh J, Weller PF. Eosinophils and Eosinophilia. In: Rich RR, ed. Clinical Immunology Principles and Practice. 4th ed. London.Elsevier Saunders, 2013:298-309
2. Johansson MW. Activation states of blood eosinophils in asthma. Clin Exp Allergy. 2014;44(4):482-498.
3. Johansson MW. Eosinophil Activation Status in Separate Compartments and Association with Asthma. Front Med (Lausanne). 2017;4:75.
4. Soman KV, Stafford SJ, Pazdrak K, et al. Activation of Human Peripheral Blood Eosinophils by Cytokines in a Comparative Time-Course Proteomic/Phosphoproteomic Study. J Proteome Res. 2017;16(8):2663-2679.
5. Bochner BS. Systemic activation of basophils and eosinophils: markers and consequences. J Allergy Clin Immunol. 2000;106(5 Suppl):S292-302.
6. Pazdrak K, Young TW, Straub C, Stafford S, Kurosky A. Priming of eosinophils by GM-CSF is mediated by protein kinase CbetaII-phosphorylated L-plastin. J Immunol. 2011;186(11):6485-6496.
7. Radonjic-Hosli S, Simon HU. Eosinophils. Chem Immunol Allergy. 2014;100:193-204.
8. Ramirez GA, Yacoub MR, Ripa M, et al. Eosinophils from physiology to disease: a comprehensive review. Biomed Res Int. 2018;2018:9095275.

9. Farhan RK, Vickers MA, Ghaemmaghami AM, Hall AM, Barker RN, Walsh GM. Effective antigen presentation to helper T cells by human eosinophils. Immunology. 2016;149(4):413-422.
10. Kong H, DePaoli AM, Breder CD, Yasuda K, Bell GI, Reisine T. Differential expression of messenger RNAs for somatostatin receptor subtypes SSTR1, SSTR2 and SSTR3 in adult rat brain: analysis by RNA blotting and in situ hybridization histochemistry. Neuroscience. 1994;59(1):175-184.
11. Kuang FL. Approach to patients with eosinophilia. Med Clin North Am. 2020;104(1):1-14.
12. Weller PF, Klion AD. Approach to the patient with unexplained eosinophilia. Erişim tarihi: 31 Ocak 2024: https://www.uptodate.com/contents/approach-to-the-patient-with-unexplained-eosinophilia.
13. Akuthota P, Weller PF. Spectrum of eosinophilic end-organ manifestations. Immunol Allergy Clin North Am. 2015;35(3):403-411.
14. Weller PF, Klion AD. Eosinophil biology and causes of eosinophilia. Erişim tarihi: 31 Ocak 2024: https://www.uptodate.com/contents/eosinophil-biology-and-causes-of-eosinophilia.
15. Costagliola G, Marco SD, Comberiati P, et al. Practical Approach to children presenting with eosinophila and hypereosinophilia. Curr Pediatr Rev. 2020;16(2):81-88.
16. Schwartz JT, Fulkerson PC. An Approach to the evaluation of persistent hypereosinophilia in pediatric patients. Front Immunol. 2018;9:1944.
17. Bayram RO, Ozdemir H, Emsen A, Turk Dagi H, Artac H. Reference ranges for serum immunoglobulin (IgG, IgA, and IgM) and IgG subclass levels in healthy children. Turk J Med Sci. 2019;49(2):497-505.
18. Kostikas K, Brindicci C, Patalano F. Blood eosinophils as biomarkers to drive treatment choices in asthma and COPD. Curr Drug Targets. 2018;19(16):1882-1896.
19. Lombardi C, Berti A, Cottini M. The emerging roles of eosinophils: Implications for the targeted treatment of eosinophilic-associated inflammatory conditions. Curr Res Immunol. 2022;3:42-53.
20. Khoury P, Makiya M, Klion AD. Clinical and biological markers in Hypereosinophilic Syndromes. Front Med (Lausanne). 2017;4:240.
21. Brusselle G, Pavord ID, Landis S, et al. Blood eosinophil levels as a biomarker in COPD. Respir Med. 2018;138:21-31.
22. Katz LE, Gleich GJ, Hartley BF, Yancey SW, Ortega HG. Blood eosinophil count is a useful biomarker to identify patients with severe eosinophilic asthma. Ann Am Thorac Soc. 014;11(4):531-536.
23. Ness TE, Erickson TA, Diaz V, et al. Pediatric Eosinophilia: a review and multiyear investigation into etiologies. J Pediatr. 2023;253:232-237 e231.
24. Çelik İK, Büyüktiryaki B, Açıkgöz FG, et al. Evaluation of etiological factors causing hypereosinophilia ın children. Turkish J Pediatr Dis. 2021;15:373-378.
25. Rothenberg ME. Eosinophilia. N Engl J Med. 1998;338(22):1592-1600.
26. Nazer H, Greer W, Donnelly K, et al. The need for three stool specimens in routine laboratory examinations for intestinal parasites. Br J Clin Pract. 1993;47(2):76-78.
27. Marti H, Koella JC. Multiple stool examinations for ova and parasites and rate of false-negative results. J Clin Microbiol. 1993;31(11):3044-3045.
28. Munzer D. New perspectives in the diagnosis of Echinococcus disease. J Clin Gastroenterol. 1991;13(4):415-423.
29. Bonilla FA, Khan DA, Ballas ZK, et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015;136(5):1186-1205 e1181-1178.
30. Yazdani R, Azizi G, Abolhassani H, Aghamohammadi A. Selective IgA deficiency: epidemiology, pathogenesis, clinical phenotype, diagnosis, prognosis and management. Scand J Immunol. 2017;85(1):3-12.
31. Kılıç M, Taşkın E, Selmanoğlu A. Primer immün yetmezlikli olgularımızın retrospektif değerlendirilmesi. Firat Medical J. 2015;20:37–42.
32. Marschall K, Hoernes M, Bitzenhofer-Gruber M, et al. The Swiss National Registry for primary immunodeficiencies: report on the first 6 years' activity from 2008 to 2014. Clin Exp Immunol. 2015;182(1):45-50.
33. Williams KW, Milner JD, Freeman AF. Eosinophilia associated with disorders of immune deficiency or immune dysregulation. Immunol Allergy Clin North Am. 2015;35(3):523-544.
34. Ring J. History of Allergy: Clinical descriptions, pathophysiology, and treatment. Handb Exp Pharmacol. 2022;268:3-19.
35. Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils, and eosinophils. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S73-80.
36. Bochner BS. Siglec-8 on human eosinophils and mast cells, and Siglec-F on murine eosinophils, are functionally related inhibitory receptors. Clin Exp Allergy. 2009;39(3):317-324.
37. Na HJ, Hamilton RG, Klion AD, Bochner BS. Biomarkers of eosinophil involvement in allergic and eosinophilic diseases: review of phenotypic and serum markers including a novel assay to quantify levels of soluble Siglec-8. J Immunol Methods. 2012;383(1-2):39-46.