eMedicine Specialties > Hematology > Immune System and Disorders

Eosinophilia: Treatment & Medication

Author: Michaelann Liss, DO, Consulting Staff, Department of Hematology/Oncology, The Vancouver Clinic/ South West Washington Medical Center
Coauthor(s): Erik Zeger, MD, Consulting Staff, Main Line Oncology Hematology Associates; Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences; Palaniandy Kogulan, MBBS, MD, Assistant Director of Internal Medicine, Synergy Medical Education Alliance; Assistant Professor of Medicine, Michigan State University College of Human Medicine
Contributor Information and Disclosures

Updated: May 21, 2009

Treatment

Medical Care

A detailed discussion of therapeutics for the many individual causes of eosinophilia, including parasitic and malignancy-associated forms, are beyond the scope of this article. General guidelines only are addressed here.

  • Most cases of secondary eosinophilia are treated based on their underlying causes. Allergic and connective tissue disorders may be amenable to corticosteroid treatment. Parasitic and fungal infections can be worsened or disseminated by use of steroids and should be ruled out if they are indicated by patient history.
  • In patients with primary eosinophilia without organ involvement, no treatment may be necessary. Cardiac function should be evaluated at regular intervals, however, as peripheral eosinophilia does not necessarily correlate with organ involvement. Steroid responsiveness should be evaluated, both for prognosis (steroid-responsive patients do better) and to guide treatment when needed.
  • Choices for systemic treatment of primary eosinophilia with organ involvement initially include corticosteroids and interferon (IFN)-alpha for steroid resistant disease. Other agents for steroid resistant disease include hydroxyurea, chlorambucil, vincristine, cytarabine, 2-chlorodeoxyadenosine (2-CdA), and etoposide. These agents are usually given as chronic maintenance regimens to control organ involvement. In the presence of PDGFRA and PDGFRB mutations, imatinib has achieved complete and durable remissions. Jain et al evaluated the use of imatinib in 18 patients with hypereosinophilic syndrome (HES) with known and unknown PDGFRalpha status.10 The investigators confirmed a low response rate to imatinib in HES patients with unknown or negative PDGFRalpha status. Jain et al concluded that new therapeutic options are needed for hypereosinophilic syndrome (HES).10 In refractory cases, many investigational combinations of chemotherapeutic agents, tyrosine kinase inhibitors and monoclonal antibodies are being studied. Nonmyeloablative allogenic hematopoietic stem cell transplantation (HSCT) can also be considered in drug-refractory cases.

Surgical Care

Surgical care may be indicated in patients with eosinophilia, depending on the specific diagnosis.

Consultations

Consultation with infectious disease and hematology-oncology physicians can help determine the cause and treatment of eosinophilia.

Medication

Specific medications for the many infectious, allergic, and hematologic-oncologic diseases associated with eosinophilia are beyond the scope of this article, which focuses on the causes of eosinophilia. A brief overview is provided under the heading of Medical Care.

More on Eosinophilia

Overview: Eosinophilia
Differential Diagnoses & Workup: Eosinophilia
Treatment & Medication: Eosinophilia
Follow-up: Eosinophilia
Multimedia: Eosinophilia
References
Further Reading
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References

  1. Spry CJF, ed. Eosinophils: A Comprehensive Review and Guide to the Scientific and Medical Literature. Oxford, UK: Oxford University Press; 1988.

  2. Gotlib J. Molecular classification and pathogenesis of eosinophilic disorders: 2005 update. Acta Haematol. 2005;114(1):7-25. [Medline].

  3. Tefferi A, Patnaik MM, Pardanani A. Eosinophilia: secondary, clonal and idiopathic. Br J Haematol. Jun 2006;133(5):468-92. [Medline].

  4. Weller PF, Bubley GJ. The idiopathic hypereosinophilic syndrome. Blood. May 15 1994;83(10):2759-79. [Medline]. [Full Text].

  5. Bain BJ. Relationship between idiopathic hypereosinophilic syndrome, eosinophilic leukemia, and systemic mastocytosis. Am J Hematol. Sep 2004;77(1):82-5. [Medline]. [Full Text].

  6. Gotlib J, Cools J, Malone JM 3rd, et al. The FIP1L1-PDGFRalpha fusion tyrosine kinase in hypereosinophilic syndrome and chronic eosinophilic leukemia: implications for diagnosis, classification, and management. Blood. Apr 15 2004;103(8):2879-91. [Medline]. [Full Text].

  7. Tefferi A. Modern diagnosis and treatment of primary eosinophilia. Acta Haematol. 2005;114(1):52-60. [Medline].

  8. Fletcher S, Bain B. Eosinophilic leukaemia. Br Med Bull. 2007;81-2:115-27. [Medline]. [Full Text].

  9. Weller PF. Eosinophilia in travelers. Med Clin North Am. Nov 1992;76(6):1413-32. [Medline].

  10. Jain N, Cortes J, Quintas-Cardama A, et al. Imatinib has limited therapeutic activity for hypereosinophilic syndrome patients with unknown or negative PDGFRalpha mutation status. Leuk Res. Jun 2009;33(6):837-9. [Medline].

  11. Allen JN, Davis WB. Eosinophilic lung diseases. Am J Respir Crit Care Med. Nov 1994;150(5 Pt 1):1423-38. [Medline].

  12. Butterfield JH. Success of short-term, higher-dose imatinib mesylate to induce clinical response in FIP1L1-PDGFRalpha-negative hypereosinophilic syndrome. Leuk Res. Aug 2009;33(8):1127-9. [Medline].

  13. Cohen AJ, Steigbigel RT. Eosinophilia in patients infected with human immunodeficiency virus. J Infect Dis. Sep 1996;174(3):615-8. [Medline].

  14. Cortes J, Ault P, Koller C, et al. Efficacy of imatinib mesylate in the treatment of idiopathic hypereosinophilic syndrome. Blood. Jun 15 2003;101(12):4714-6. [Medline]. [Full Text].

  15. Fink SR, Belongie KJ, Paternoster SF, et al. Validation of a new three-color fluorescence in situ hybridization (FISH) method to detect CHIC2 deletion, FIP1L1/PDGFRA fusion and PDGFRA translocations. Leuk Res. Jun 2009;33(6):843-6. [Medline].

  16. Heimall J, Freeman A, Holland SM. Pathogenesis of hyper IgE syndrome. Clin Rev Allergy Immunol. May 19 2009;epub ahead of print. [Medline].

  17. Lucey DR, Clerici M, Shearer GM. Type 1 and type 2 cytokine dysregulation in human infectious, neoplastic, and inflammatory diseases. Clin Microbiol Rev. Oct 1996;9(4):532-62. [Medline]. [Full Text].

  18. [Best Evidence] [Best Evidence] Nair P, Pizzichini MM, Kjarsgaard M, et al. Mepolizumab for prednisone-dependent asthma with sputum eosinophilia. N Engl J Med. Mar 5 2009;360(10):985-93. [Medline].

  19. Nand R, Bryke C, Kroft SH, et al. Myeloproliferative disorder with eosinophilia and ETV6-ABL gene rearrangement: efficacy of second-generation tyrosine kinase inhibitors. Leuk Res. Aug 2009;33(8):1144-6. [Medline].

  20. Roufosse F, Goldman M, Cogan E. Hypereosinophilic syndrome: lymphoproliferative and myeloproliferative variants. Semin Respir Crit Care Med. Apr 2006;27(2):158-70. [Medline].

  21. Tefferi A, Pardanani A. Imatinib therapy in clonal eosinophilic disorders, including systemic mastocytosis. Int J Hematol. Jun 2004;79(5):441-7. [Medline].

  22. Tostes Oliveira D, Tjioe KC, et al. Tissue eosinophilia and its association with tumoral invasion of oral cancer. Int J Surg Pathol. Jul 2009;17(3):244-9. [Medline].

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Further Reading

Related eMedicine Topics

Clinical Trials
National Guideline Clearinghouse

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Keywords

eosinophilia, eosinophilic leukocytes, idiopathic hypereosinophilic syndrome, HES, CHINA, Ascaris lumbricoides, Loffler syndrome, simple pulmonary eosinophilia, tropical eosinophilia, angiolymphoid hyperplasia with eosinophilia, eosinophilia-myalgia syndrome, leukocyte disorders, helminthic infection

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Contributor Information and Disclosures

Author

Michaelann Liss, DO, Consulting Staff, Department of Hematology/Oncology, The Vancouver Clinic/ South West Washington Medical Center
Michaelann Liss, DO is a member of the following medical societies: American College of Physicians, American Medical Association, American Osteopathic Association, American Physical Therapy Association, American Society of Hematology, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Erik Zeger, MD, Consulting Staff, Main Line Oncology Hematology Associates
Erik Zeger, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, and American Society of Hematology
Disclosure: Nothing to disclose.

Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences
Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians
Disclosure: Nothing to disclose.

Palaniandy Kogulan, MBBS, MD, Assistant Director of Internal Medicine, Synergy Medical Education Alliance; Assistant Professor of Medicine, Michigan State University College of Human Medicine
Palaniandy Kogulan, MBBS, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Pradyumna D Phatak, MBBS, MD,, Chair, Division of Hematology and Medical Oncology, Rochester General Hospital; Clinical Professor of Oncology, Roswell Park Cancer Institute
Pradyumna D Phatak, MBBS, MD, is a member of the following medical societies: American Society of Hematology
Disclosure: Novartis Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Marcel E Conrad, MD, (Retired) Distinguished Professor of Medicine, University of South Alabama
Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, and Southwest Oncology Group
Disclosure: No financial interests None None

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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