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

Öz

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.

Anahtar Kelimeler

• Allergy consultation
• Eosinophilia
• Eosinophil-related disorders
• Hypereosinophilia
• Hypereosinophilic syndrome.

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

Öz

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.

Anahtar Kelimeler

• Alerji konsültasyonu
• Eozinofili
• Eozinofil-iliş-kili hastalıklar
• Hipereozinofili
• Hipereozinofilik sendrom

Kaynakça

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