USE OF DIETARY SUPPLEMENTS AS A CAUSE OF SECONDARY HYPEREOSINOPHILIA

Abstract

Introduction Our case highlights the development of asymptomatic secondary blood hypereosinophilia after starting various dietary supplements. Case Description A 71-year old healthy female presented for evaluation of incidental asymptomatic hypereosinophilia. She had recently re-established primary care and had routine blood tests showing an absolute eosinophil count of 1600/mm3 and repeat 1,800/mm3 (compared to 700/mm3 two months prior and 100/mm3 fifteen years prior) with otherwise normal differential. Peripheral blood smear had normal eosinophilic morphology; remaining evaluation showed no evidence of end organ involvement, infection, occult malignancy, or rheumatologic disease. Her medication list was revealing for only non-pharmaceutical medications started within the past year and included 8 multivitamins/minerals, 2 herbal supplements, 2 digestive supplements, 1 probiotic, DHEA (dehydroepiandrosterone), and pregnenolone. Ingredients included bromelain, cellulase, peptidase, papain and pepsin among other proteins. We recommended that she discontinue all supplements; she continued vitamins and minerals based on personal preference. She followed these instructions and repeat labs 1 month after discontinuation showed normalization of absolute eosinophils to 100/mm3. Discussion The etiology of the patient's eosinophilia is based on temporal onset and spontaneous resolution in relation to supplement use and its discontinuation. While it is difficult to determine the exact culprit among these multiple substances that were discontinued simultaneously, physicians should recognize that ingredients found in dietary supplements, some of which contain enzymes and other proteins, may cause secondary hypereosinophilia. There is sparse literature describing cases of asymptomatic hypereosinophilia due to dietary supplements. Given their widespread use, a history of supplement use should be obtained when evaluating unexplained eosinophilia.