Eosinophil Count In Patients Research Articles

Churg–Strauss syndrome associated with omalizumab

Reports have suggested that the leukotriene receptor antagonists may cause Churg–Strauss syndrome following the tapering of oral corticosteroids or even in patients not treated with corticosteroids. We report a patient not treated with long-term corticosteroids and who developed Churg–Strauss syndrome with myocarditis and central nervous system involvement following the initiation of omalizumab. Given the possible role of omalizumab in the development of this vasculitis in our patient, we recommend careful monitoring of the appearance of Churg–Strauss symptoms and rising eosinophil count in patients treated with omalizumab.

Agreement rate of skin prick test with tissue eosinophil count in patients with nasal polyps.

The pathogenetic mechanism of nasal polyps remains unknown, although allergy has been cited as an important factor in the etiology of nasal polyposis. Currently there is no definite histological criterion for differentiation of allergic from inflammatory nasal polyp. However, in a few studies, tissue eosinophil count has been used for this. This study aimed to find out the agreement rate of skin prick test and tissue eosinophil count in patients with nasal polyposis. Twenty five patients (18 males, 7 females) with nasal polyp were enrolled in this study. For each patient tissue sample from polyp material was taken for histopathological investigation. Moreover, skin prick test was performed for each patient using eleven common aeroallergens. Skin prick test was positive in 48% of the patients. Tissue eosinophil count of more than 50% was found in 75% of skin prick positive and in 69.2% of skin prick negative patients. Also tissue eosinophil count of more than 50% was found in 69.2% of patients with typical allergic symptoms as well as 75% of patients without allergic symptoms. No agreement was found between skin prick tests and tissue eosinophil counts in patients with nasal polyp. Also no difference was found between the tissue eosinophil counts in allergic and non allergic patients. Considering these results, it can be concluded that having a high tissue eosinophil count in patients with nasal polyp does not indicate that the polyp is allergic.

821 Effects of Mepolizumab, an Anti-Interleukin-5 Monoclonal Antibody, on Blood Eosinophil Counts in Patients With Hypereosinophilic Syndrome

821 Effects of Mepolizumab, an Anti-Interleukin-5 Monoclonal Antibody, on Blood Eosinophil Counts in Patients With Hypereosinophilic Syndrome

Steroid-Sparing Effects of Anti-IL-5 Monoclonal Antibody (Mepolizumab) Therapy in Patients with HES: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial.

An international, multicenter, randomized, double-blind, placebo-controlled, parallel-group trial has evaluated the effects of mepolizumab, a humanized anti-interleukin-5 monoclonal antibody, on therapeutic prednisone dose requirements, eosinophil levels, signs and symptoms of disease in patients with hypereosinophilic syndrome (HES). The trial enrolled 85 patients (mean age 48.1 years) with HES (blood eosinophil count >1500/μl with evidence of eosinophil-related organ involvement or dysfunction and no known cause of eosinophilia), who tested negative for the FIP1L1-PDGFRα gene rearrangement and required 20–60 mg/day prednisone monotherapy to maintain blood eosinophils at <1000 cells/μL during a run-in period of ≤6 weeks. Patients were randomized to treatment with intravenous mepolizumab 750 mg (n=43) or saline (placebo; n=42) every 4 weeks for 36 weeks (final infusion at Week 32). The prednisone dose was tapered at weekly intervals following the first infusion according to a predefined algorithm based on blood eosinophil counts and HES clinical activity criteria. A total of 84% of patients in the mepolizumab group vs 43% in the placebo group (P<0.001) achieved the primary endpoint (≤10 mg/day prednisone for ≥8 consecutive weeks within the 36-week treatment period). Time to achievement of the primary endpoint, a post-hoc analysis, was significantly shorter in mepolizumab- vs placebo-treated patients (P=0.002). Significantly higher proportions of patients on mepolizumab achieved pre-defined secondary steroid-sparing and eosinophil endpoints vs placebo (Table). Initial assessments of cutaneous disease (based on pruritus visual analog scales and erythema/edema scores) did not differ between the treatment groups. This study, the largest placebo-controlled trial to be conducted in patients with HES to date, has shown that mepolizumab is more effective than placebo at reducing therapeutic prednisone use and stabilizing eosinophil counts in patients with HES. Importantly, a significantly higher proportion of HES patients treated with mepolizumab than placebo achieved the primary endpoint and required ≤10 mg/day prednisone for at least 8 consecutive weeks. These findings indicate that mepolizumab will be an effective therapy for FIP1L1-PDGFRα negative patients with HES.Primary and secondary endpointsEndpointPlacebo (n=42)Mepolizumab (n=43)P-value (95% CI)Patients on ≤10 mg/day prednisone for ≥8 weeks (primary endpoint), %43%84%<0.001 (2.69, 23.78)Patients with eosinophils <600 μL for ≥8 weeks, %45%95%<0.001 (4.74, 75.17)Primary endpoint in patients on ≤30 mg/day prednisone at baseline, %57% (n=30)87% (n=30)0.011 (1.39, 17.82)Primary endpoint in patients on >30 mg/day prednisone at baseline, %8% (n=12)77% (n=13)<0.001 (3.26, 412.26)Patients achieving ≤7.5 mg/day prednisone during the treatment period, %50%86%<0.001 (2.04, 15.00)Mean (±SE) prednisone dose at Week 36 (adjusted), mg/day21.8±1.926.2±1.87<0.001

The relationship between the nasal symptoms and the eosinophil count in patients with perennial allergic rhinitis The effect of cetirizine hydrochloride (Zyrtec&reg;)

The relationship between the nasal symptoms and the eosinophil count in patients with perennial allergic rhinitis The effect of cetirizine hydrochloride (Zyrtec&reg;)

Chronic Sinusitis with Nasal Polyps: Staphylococcal Exotoxin Immunoglobulin E and Cellular Inflammation

The etiology of chronic sinusitis with nasal polyposis (CS/NP) remains enigmatic. Frequently, Staphylococcus aureus is present in the nose of CS/NP patients, although the significance is unclear. Recent reports have suggested the hypothesis that these bacteria may secrete exotoxins triggering the inflammatory mucosal changes seen in CS/NP. This mechanism of immunopathology has been established in other diseases associated with Staphylococcus colonization and exotoxin secretion such as atopic dermatitis. In atopic dermatitis, the exotoxins incite a local superantigen response in which clonal T-cell activation and massive cytokine release occur in the affected skin. Second, these exotoxins can act as traditional allergens, stimulating a typical immunoglobulin E (IgE) response in the serum, which has been correlated with disease severity. This study is designed to begin the assessment of the hypothesis that a similar mechanism takes place in CS/NP. Serum was drawn from patients with CS/NP undergoing endoscopic sinus surgery as well as 13 atopic and nonatopic control subjects without sinusitis. IgE levels to S. aureus exotoxins A (SEA), SE exotoxins B (SEB), and toxic shock syndrome toxin 1 were measured using enzyme-linked immunosorbent assay. Tissue eosinophilia and the presence of lymphocytes on hemotoxylin and eosin-stained sections of polyps were scored by a blinded pathologist and correlated to presence of toxin IgE in the serum. Staphylococcal exotoxin (SE)-specific IgE was found in the serum of 5/10 (50%) of the patients with CS/NP. In contrast, 0/13 control patients had IgE to the exotoxins (p = 0.031). Polyp eosinophil, lymphocyte, and mononuclear cell counts were compared in IgE exotoxin-positive and -negative subjects. A trend toward increased eosinophil counts in patients with SE IgE (SE IgE+) was present, but not statistically significant. These results indicate that a high percentage of CS/NP patients show a systemic IgE response to S. aureus exotoxins in comparison with controls without CS/NP. Although these results are consistent with the actions of Staphylococcus toxins in other diseases, additional work is necessary to establish a local superantigen response in the nasal mucosa of CS/NP patients.

Changes in the peripheral eosinophil count in patients with acute eosinophilic myocarditis.

In many cases, the diagnosis of eosinophilic myocarditis is suggested by an elevated peripheral blood eosinophil count. However, no detailed studies have been performed on the sequential changes in the initial peripheral blood eosinophil count over the course of the disease. We measured the peripheral blood eosinophil count at the time of presentation in eight patients with eosinophilic myocarditis proven by endomyocardial biopsy and intermittently thereafter. The eosinophil count at the time of onset was <500/mm(3) in four patients, >500/mm(3) but <1,000/mm(3) in three patients, and > or =1,000/mm(3) in one patient. In three of the four patients with an initial eosinophil count of <500/mm(3), an increase to > or =500/mm(3) occurred 7-12 days after the onset. The remaining patient did not develop peripheral eosinophilia. In conclusion, in the early stage of eosinophilic myocarditis, peripheral hypereosinophilia is not present initially in some patients, and may not develop during the course of the illness in a subset of these patients.

Serum levels of vasoactive intestinal peptide are elevated in patients with atopic dermatitis

Vasoactive intestinal peptide (VIP) has been suggested to play some roles in atopic dermatitis. Tissue of VIP levels has been reported to increase in chronic lichenified lesions of atopic dermatitis (AD). To analyze whether serum levels of VIP in AD patients are elevated compared with normal controls and correlated with the disease severity, we measured serum levels of VIP using enzyme-linked immunosorbent assay in 53 patients with AD and 21 healthy individuals. The results showed that serum levels of VIP in AD patients (345.8±71.5 μg/ml) were significantly higher than those in healthy individuals (307.1±42.6 μg/ml). However, a correlation was not found between serum VIP levels and disease severity, other markers including serum LDH levels, total serum IgE levels, and peripheral blood eosinophil counts in patients with AD. This indicates that VIP levels in AD patients were elevated not only in the skin but also in the serum, suggesting that increased serum VIP levels in the patients with AD might be involved in its pathogenesis.

Erratum to : Relationship of the Severity of Atopic Dermatitis with Nonspecific IgE, Serum LDH, Eosinophil Counts in Patients Given the Anti-allergic Agent Oxatomide

Erratum to : Relationship of the Severity of Atopic Dermatitis with Nonspecific IgE, Serum LDH, Eosinophil Counts in Patients Given the Anti-allergic Agent Oxatomide

Relationship of the Severity of Atopic Dermatitis with Nonspecific IgE, Serum LDH, Eosinophil Counts in Patients Given the Anti-allergic Agent Oxatomide

Relationship of the Severity of Atopic Dermatitis with Nonspecific IgE, Serum LDH, Eosinophil Counts in Patients Given the Anti-allergic Agent Oxatomide

Peripheral blood eosinophil counts and eosinophil cationic protein content of respiratory secretions in bronchiolitis: relationship to severity of disease

Infants and young children with acute viral respiratory illness were studied to determine the association of peripheral blood eosinophil counts and concentrations of eosinophil cationic protein (ECP) in nasopharyngeal secretions with the development and severity of bronchiolitis. Subjects included those with upper respiratory illness (URI) alone, pneumonia or bronchiolitis. Controls consisted of healthy infants, and those hospitalized with non-respiratory illnesses. While peripheral blood eosinophil counts were suppressed in all infected infants greater than two months of age, eosinophil counts in patients with bronchiolitis were significantly greater than in those with URI alone. ECP concentrations were significantly greater among individuals with bronchiolitis than other infected infants. For bronchiolitis cases with detectable peripheral blood eosinophils, eosinophil counts correlated weakly and inversely with oxygen saturations. In contrast, ECP concentrations were strongly inversely correlated with initial oxygen saturation. ECP concentrations were also significantly correlated with peripheral blood eosinophil counts. Viral infections suppress peripheral blood eosinophil counts in infants greater than two months of age, although the effect is somewhat overcome in patients with bronchiolitis. The form and severity of bronchiolitis is much more strongly related to degranulation of eosinophils in the respiratory tract than to peripheral blood eosinophil counts.

Serum levels of major basic protein in patients with or without eosinophilia: measurement by enzyme‐linked immunosorbent assay

A bone marrow proteoglycan (BMPG) has been purified which consists of the same amino acid sequence as that of pro-MBP, and produced two anti-BMPG mAbs. Serum levels of major basic protein (MBP), a cationic protein rich in the eosinophil granule, were measured in patients with eosinophilia or allergic diseases by an enzyme-linked immunosorbent assay (ELISA) using these mAbs. The serum levels of MBP in patients with eosinophilia (n = 64) and in those with allergic diseases without eosinophilia (n = 32) were elevated significantly (P < 0.001 and P = 0.038, respectively). There was a weak positive correlation between the serum levels of MBP and the eosinophil counts in the patients with eosinophilia (r = 0.38). Among these patients, extremely high serum levels of MBP were found in those with hypereosinophilic syndrome (HES) and Kimura's disease. Serum levels of MBP decreased more slowly than the eosinophil counts in patients with eosinophilia when treated by glucocorticoids. We conclude that measurement of serum levels of MBP is useful in evaluating the total-body proliferation and infiltration of eosinophils more accurately than following-up the eosinophil counts alone.

Endomyocardial fibrosis and eosinophilia.

Absolute eosinophil counts were assessed in 15 African patients with proven endomyocardial fibrosis. Though the mean eosinophil count in patients with endomyocardial fibrosis was higher compared with the normals reported from Kampala (1-13 vs 0.72X10(9)/1), the absolute range was comparable. A high percentage of patients with endomyocardial fibrosis had malarial parasites, high malarial antibody titres, hookworms, or strongyloides, but the correlation of eosinophilia to various parasitic infections was poor. Both eosinophilia and parasitic infections are common in the tropics and they effect patients with endomyocardial fibrosis no more than the population at large. Other aetiological factors, genetic, environmental, and immunological, are felt to be important in the causation of endomyocardial fibrosis in Uganda and evidence for this is reviewed. Though there is a similarity in pathological features, African endomyocardial fibrosis is a distinct entity from Löffler's endocarditis and cardiac lesions seen in eosinophilic leukaemia or reactive eosinophilia. There is no hard evidence to suggest that African endomyocardial fibrosis is a variant of Löffler's endocarditis caused by parasitic infections via eosinophilia.

DECREASES IN BLOOD EOSINOPHILIC LEUKOCYTES AFTER ELECTRICALLY INDUCED CONVULSIONS IN MAN

THE data of earlier work (1, 2, 3, 4, 5, 6) indicate the occurrence of strong stimulation of the adrenal cortex during and after convulsions induced electrically in the treatment of mental disease. The possible importance of increased secretion of some steroid hormones in causing the beneficial response to electroconvulsive therapy is suggested by clinical studies on the effects of testosterone in large doses in patients in relapse after having recovered from mental disease as a consequence of shock therapy (7). The steroid hormones are known to have several different functions. In an attempt to gain insight into which of these functions might be important in relation to the beneficial effects of shock therapy, it was decided to study the blood eosinophil count in patients given this form of treatment. Twenty-one patients, ranging in age from 22 to 65 years, were studied; 14 were women. The diagnoses were various (Table 1). Some of the patients had been ill for long periods but none was more than slightly deteriorated. In the case of the patients with schizophrenia, the clinical course was variable but none of the patients was entirely well for any prolonged period. The patients with manic-depressive psychoses, on the other hand, had periods of complete normality of some duration; in these instances the duration of the present attack is indicated in parentheses in Table 1.