Assessment of eosinophilia

Eosinophilia is defined as an increase in the peripheral blood eosinophil count. The upper limit of normal is usually taken as about 0.6 × 10⁹/L (600/microlitre), but it is lower (about 0.4 × 10⁹/L [400/microlitre]) if people with minor allergies are excluded. There is no ethnic variation in the normal eosinophil count and no physiological cause of an increased count.[1]Bain BJ. Blood cells: a practical guide. 6th ed. Oxford: Wiley-Blackwell; 2022.

Causes of eosinophilia

The most common causes of eosinophilia depend on socioeconomic and geographical factors. In the developing world the most common cause is parasitic infection (and parasitic infections result in the greatest number of cases worldwide), whereas in the developed world it is allergy. Uncommon and rare causes are important because eosinophilia may be the result of a serious underlying condition.

Hypereosinophilia

The terms eosinophilia and hypereosinophilia do not have precise definitions, and several different classifications of eosinophilic disorders have been proposed. Peripheral blood eosinophilia has traditionally been divided into mild (0.5-1.49 × 10⁹/L [500-1499/microlitre]), moderate or marked (1.5-5.0 × 10⁹/L [1500-5000/microlitre]), and severe (>5.0 × 10⁹/L [>5000/microlitre]). Consensus recommendations define persistent hypereosinophilia as >1.5 × 10⁹/L (>1500/microlitre) recorded on at least 2 occasions ≥2 weeks apart.[2]Valent P, Klion AD, Roufosse F, et al. Proposed refined diagnostic criteria and classification of eosinophil disorders and related syndromes. Allergy. 2023 Jan;78(1):47-59. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9797433 http://www.ncbi.nlm.nih.gov/pubmed/36207764?tool=bestpractice.com ​ The higher the eosinophil count, the more urgent it is to determine the cause, first because the underlying disease may need treatment in its own right, and second because hypereosinophilia can lead to tissue damage, which can be life-threatening. If eosinophils are extensively degranulated, tissue damage is more likely because of the enzymes, cytotoxic proteins, and cytokines released.[2]Valent P, Klion AD, Roufosse F, et al. Proposed refined diagnostic criteria and classification of eosinophil disorders and related syndromes. Allergy. 2023 Jan;78(1):47-59. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9797433 http://www.ncbi.nlm.nih.gov/pubmed/36207764?tool=bestpractice.com

Investigation of eosinophilia

Follows the traditional model of clinical history, physical examination, and laboratory and other investigations, taking into account the likely causes in the individual patient.