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Eosinophilia

Jul 25, 2019

Eosinophilia is  raised eosinophil count in the peripheral blood (more than 4.5×109/L). Symptoms range from fever, weight loss, urticaria, angioedema, chest pain, cough, breathlessness, dizziness and or lymphadenopathy. It can be due to wide range of conditions such as allergies, parasitic infections, bacterial infection, eczema, Addison’s disease, myeloproliferative diseases, etc. and it is important to treat underlying conditions simultaneously.

 Medications:

Start tab. Medrol (Methylprednisolone) 8mg and 4mg tablets –

  • Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
  • Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
  • Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
  • Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
  • Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
  • Day 6: 4 mg orally (4 mg before breakfast)

Always give steroids with PPI cover i.e Pantakind (pantoprazole 20mg).

Tab. Hetrazan (Diethylcarbamazine 100 mg) –

  • Day 1 and 2 – no treatment to provide initial steroid cover
  • Day 3 – Half tablet once a day
  • Day 4 – Half tablet twice a day
  • Day 5 – One tablet twice a day
  • Day 6 to 21 – One tablet thrice a day

Symptomatic treatments:

  • For cough- Syrup. Benadryl DR (Dextromethorphan 15 mg) 10 mls 3 times a day.

General advice:

  • Advice deworming treatment if necessary
  • Advice six-food elimination diet – stop foods containing milk, wheat, eggs, soy, all types of nuts, and seafoods products.

Investigations:

  • Complete blood count (CBC) and peripheral blood smear – to check the severity of disease, absolute eosinophil count >4.5×109/L.
  • Stool microscopy for parasites.
  • Liver function test, renal function test – to look for organ damage.
  • 8 am serum cortisol – to rule out Addison’s disease.
  • Vitamin B12, tryptase levels – may be high.
  • Cardiac test – Troponin, ECG, echo cardiogram to scan cardiac damage.
  • Chest X-ray, CT chest – to evaluate for respiratory complications or aspergillosis as the cause of eosinophilia.

Referral:

Consider referral to haematologist if patient fails to respond or if presents with additional complications.