Tropical Eosinophilia: To the Editor:

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We are very grateful to Drs. Chitkara and Donath for their keen interest and appreciation in our article, “Airway hyperreactivity in tropical pulmonary eosinophilia” (Chest 1988; 93:1105-06).We agree entirely that asthma and tropical pulmonary eosinophilia can have common features such as cough, wheeze, eosinophilia and obstructive ventilatory defect. However, the cases reported have positive filarial serology and reticulo-nodular infiltrates on the chest x-ray films. Therefore, these are classical cases of TPE. It may not be correct to call them asthmatic. In India, we often see cases of TPE with a normal chest x-ray film, clinically presenting as refractory asthma. In such cases, TPE deserves a place in the DD. Generally, we get a good response to diethyl carbamazine therapy.TableFive Patients with Tropical Pulmonary Eosinophilia caused by AsthmaPatient No.Age/sexWBC/eos. (× 1000)/(%)Chest x-rayFilarial serologyComments142 M90/83normal1:4096Concurrent toxocariasis229 M18/69abnormal*l:512†See ref. 7345 M21/29abnormal*1:1024—448 F26/38abnormal*1:2048—531 M40/58abnormal*1:4096Shortly after varicella pneumonia*Chest x-ray showed bilateral nodular interstitial infiltrates.†Serology done two weeks after treatment Open table in a new tab I would have been very useful and informative if nonspecific bronchial hyperresponsiveness had also been determined. We are very grateful to Drs. Chitkara and Donath for their keen interest and appreciation in our article, “Airway hyperreactivity in tropical pulmonary eosinophilia” (Chest 1988; 93:1105-06). We agree entirely that asthma and tropical pulmonary eosinophilia can have common features such as cough, wheeze, eosinophilia and obstructive ventilatory defect. However, the cases reported have positive filarial serology and reticulo-nodular infiltrates on the chest x-ray films. Therefore, these are classical cases of TPE. It may not be correct to call them asthmatic. In India, we often see cases of TPE with a normal chest x-ray film, clinically presenting as refractory asthma. In such cases, TPE deserves a place in the DD. Generally, we get a good response to diethyl carbamazine therapy. *Chest x-ray showed bilateral nodular interstitial infiltrates. †Serology done two weeks after treatment I would have been very useful and informative if nonspecific bronchial hyperresponsiveness had also been determined.