Eosinophilia In Children Research Articles

Hypereosinophilia in Children and Adults: A Retrospective Comparison

The differential diagnosis of hypereosinophilia is broad and includes asthma, atopic disease, drug hypersensitivity, parasitic infection, connective tissue disorders, malignancy, and rare hypereosinophilic disorders. Hypereosinophilia in children has not been well characterized to date. The objective of this study was to identify the common causes of marked eosinophilia in children and to characterize and compare the clinical symptoms at presentation, laboratory findings, final diagnosis, and therapeutic responses between children and adults with hypereosinophilic syndromes. A retrospective analysis of consecutive subjects evaluated for unexplained eosinophilia ≥ 1.5× 10(9)/L was conducted. All subjects underwent standardized clinical and laboratory evaluations with yearly follow-up. Clinical and laboratory parameters, final diagnoses, treatment responses, and outcomes were assessed. Medians and proportions were compared using Mann-Whitney U and Fisher Exact tests, respectively. Of the 291 subjects evaluated, 37 (13%) were children and 254 were adults (87%). Whereas the frequencies of clinical hypereosinophilic syndrome (HES) variants were similar between children and adults, primary immunodeficiency was a more common secondary cause of HES in children (5% vs 0.4% in adults). Excluding subjects with treatable secondary causes, the median peak absolute eosinophil count was increased in pediatric subjects (9376 vs 5543/μL; P= .002), and children had more gastrointestinal complaints (62% vs 34%; P= .003) and less pulmonary involvement (34% vs 59%; P= .01) than adults. Despite these differences, corticosteroid responsiveness and overall prognosis were similar between the 2 groups. Although children with HES often present with higher peak eosinophil counts than adults, the differential diagnosis, clinical characteristics, and prognosis of HES are similar in the 2 groups.

OP‐23 FUNCTIONAL DYSPEPSIA IS ASSOCIATED WITH DUODENAL EOSINOPHILIA IN A PEDIATRIC COHORT

Objectives:Functional dyspepsia (FD) is a highly prevalent gastrointestinal disorder with unknown etiology. We aimed to assess the association between dyspeptic symptoms and duodenal eosinophilia in children referred for upper endoscopy.Methods:In this retrospective cohort study, all histopathology reports of normal upper endoscopies performed at a single tertiary center between 2010 and 2014 were reviewed. FD was defined as epigastric pain or discomfort for more than 2 months with no response to acid suppressants. Controls were those with non‐erosive reflux disease, dysphagia or rumination syndrome. Duodenal biopsies were analyzed by pathologists blinded to indication. Intramucosal eosinophils were counted per mm2 on haematoxylin and eosin stained digital imaged sections using Aperio eSlide Manager. Demographics, clinical variables, family history and histologic findings were compared between cases and controls.Results:In total, 36 cases and 36 non‐matched controls were identified of which 56% and 53% were female (p = 0.81). Mean (± SD) age was higher in cases compared to controls (13.6 (± 3.1) vs. 10.5 (± 4.0) years; p = .001). Dyspeptic symptoms (epigastric pain 81% and/or upper abdominal discomfort 33%) were food‐related in 69% and nocturnal in 31% of cases. Self‐reported nausea (64% vs. 17%; p < .0001), lethargy (19% vs. 0%; p = .005) and a family history of functional gastrointestinal disorders (28% vs. 3%; p = .003) were more common in cases than controls. There was a higher but not significantly different rate of atopic history (39% vs. 25%; p = .21) and psychological co‐morbidity (53% vs. 39%; p = .24) in FD cases versus controls. Duodenal intraepithelial lymphocytes per 100 enterocytes were similar in cases and controls (median (IQR) 10 (8–13) vs. 12 (8–18); p = 0.12). Duodenal eosinophil counts per mm2 were significantly increased in cases compared to controls (151 (118–207) vs. 76 (60–106); p < 0.001).Conclusions:This study confirms recent reports of duodenal eosinophilia in FD. The high rate of atopic and psychological co‐morbidity in FD suggests multi‐factorial mechanisms and may explain why current therapeutic options aimed at symptom control are largely unsatisfactory. Duodenal eosinophilia in FD should be considered a therapeutic target.

Seasonal exacerbation of esophageal eosinophilia in children with eosinophilic esophagitis and allergic rhinitis

BackgroundEvidence supports a possible link between eosinophilic esophagitis (EoE) and environmental aeroallergens, which can manifest as seasonal exacerbation of esophageal eosinophilia. Few studies have examined this link in pediatric patients with EoE. ObjectiveTo identify the proportion of patients with seasonal induced esophageal eosinophilia. MethodsA retrospective chart review was conducted of all patients diagnosed with EoE at the authors' institution. Demographic data were collected by chart review. Seasonal variation or flare was defined as a change from fewer than to at least 15 eosinophils per high-power field and a minimum of a 2-fold increase in eosinophil count between 2 consecutive biopsy specimens in different seasons without dietary or medication modifications. ResultsOf the 1,180 patients with EoE, 160 (14%) were suspected of having aeroallergen-associated triggers by history. Of these 160 patients, 32 (20%) had biopsy examination-confirmed variation of EoE triggered by aeroallergens. Most of these patients were boys (84%), all had a history or examination consistent with allergic rhinitis, and most had a history of asthma (75%). Thirty-two subjects had obvious seasonal variation, 22 of whom also had known food-induced symptoms. ConclusionChildren with EoE and allergic rhinitis might have exacerbations in their esophageal eosinophilia during certain seasons depending on the specific aeroallergens to which they are sensitized. Identification of environmental allergens to sensitized patients is important and can guide therapy.

Seasonal Exacerbation of Esophageal Eosinophilia in Children with Eosinophilic Esophagitis and Allergic Rhinitis

Seasonal Exacerbation of Esophageal Eosinophilia in Children with Eosinophilic Esophagitis and Allergic Rhinitis

Mo1678 Salivary Interleukin (IL) 5 and 4 Are Increased in Eosinophilic Esophagitis and Correlate With Esophageal Eosinophilia in Children

Mo1678 Salivary Interleukin (IL) 5 and 4 Are Increased in Eosinophilic Esophagitis and Correlate With Esophageal Eosinophilia in Children

Cause and incidence of eosinophilia in children: a single center study in one year

Purpose: Eosinophilia may be associated with various primary and reactive conditions. However, studies on the cause and incidence of eosinophilia in Korean children are rare. This study aimed to evaluate the cause and incidence of eosinophilia in patients at a single university hospital. Methods: We studied 8,285 pediatric patients under the age of 18 years who had eosinophilia at Pusan National University Hospital. Premature and newborn infants were excluded. Eosinophilia was defined as an absolute eosinophil count greater than 450/μL. Eosinophilia was categorized as mild (450–1,500/μL), moderate (1,500–5,000/μL), and severe (> 5,000/μL). The underlying conditions of eosinophilia were retrospectively investigated. Results: Of 8,285 patients who had a hematology profile, 497 (5.9%) were found to have eosinophilia. Of patients with eosinophilia, 333 patients (67.0%) had identifiable and possible causes. The major causes of eosinophilia were allergic diseases (61.3%), infectious diseases (19.8%), immunologic diseases (9.0%) and hemato-oncologic disease (5.1%). Immunological disease such as Idiopathic hypereosinophilic syndrome, drug induced hypersensitivity syndrome and Graft-versus-host disease was the common condition with moderate to severe eosinophilia in which eosinophil count in peripheral blood was more than 1,500/μL. Conclusion: The most common cause of eosinophilia was allergic disease. Immunological disease was the common condition with moderate to severe eosinophilia. (Allergy Asthma Respir Dis 2014;2:358-361)

Longitudinal Relationship between Sputum Eosinophils and Exhaled Nitric Oxide in Children with Asthma

Longitudinal Relationship between Sputum Eosinophils and Exhaled Nitric Oxide in Children with Asthma

Blood eosinophil counts rarely reflect airway eosinophilia in children with severe asthma

The inflammatory phenotypes of severe asthma in adults may be reflected in peripheral blood. If this were true in children with severe therapy-resistant asthma (STRA), invasive tests could be avoided. At the moment there is no conclusive evidence in children. All patients underwent blood tests, exhaled nitric oxide (FeNO), sputum induction, bronchoalveolar lavage (BAL) and endobronchial biopsy (EB). Sixty-three (71.6%) patients had a normal blood profile and only 1/88 had a combined blood eosinophilia and neutrophilia. 76/88 (86%) had normal blood eosinophils, but of these, 84% had airway eosinophilia in either BAL (n = 43;66%) or EB (n = 41;79%). In children with STRA blood eosinophilia was associated with airway eosinophilia. However, normal blood eosinophil levels did not exclude airway eosinophilic inflammation. Peripheral blood counts are not reliable in characterising airway inflammation in severe asthmatic children exposed to high dose steroid therapy, therefore bronchoscopy with BAL should be considered.

Clinical and Laboratory Profile of Children with Eosinophilia at Dhulikhel Hospital

Eosinophilia in children is commonly caused by or parasitic, allergic and immunologic problems. To study clinical and laboratory profile of patients with eosinophilia and to identify possible causes. A prospective and descriptive study was conducted from January 2009- December 2011. All the cases of eosinophilia with symptoms and signs of single or multiple organ were included. The known cause of eosinophilia like allergy, asthma and drugs were excluded. During three years period, 84(2.41%) cases had eosinophilia with single or multiple organ involvement. 14.3%, 39.3% and 46.4% had mild, moderate and severe eosinophilia respectively, with cases of hypereosinophilia comprising 85.7%. Eosinophilia was seen predominantly in Tamang caste with overall age ranging from 1-14 years. Most common symptoms and signs were abdominal pain (67.9%) hepatomegaly (59.5%) respectively. Gastrointestinal system was most commonly involved organ followed by respiratory system. Nineteen percent had polyserositis involving pleural, pericardial effusion and ascites at presentation. Out of 84 patients only nine serum samples were able to be sent for parasitological analysis. Sixteen cases had identifiable and/ or possible causes. Serum sample for parasitological analysis revealed fascilosis, filariasis, strongylosis, stercoralis and toxocariasis. Eosinophilia is more common among Tamang population in our study. Most common symptoms and signs are abdominal pain and hepatomegaly respectively. Parasitic infection seems to be the most common cause however further study has to be done to reach final conclusion.

Cell-mediated non-allergic rhinitis in children

ObjectiveNon-allergic rhinitis is a heterogeneous disease whose etiology is largely unknown. Nasal cytology only allows us to recognize different non-allergic rhinitis forms on the basis of the prevalent inflammatory cell infiltrate: non-allergic rhinitis with eosinophils, with neutrophils, with mast-cells and with both eosinophils and mast-cells. The aim of this study is to define the incidence, clinical features and comorbidity of the different types of cell-mediated non-allergic rhinitis in a pediatric age group. MethodsOne hundred and fourteen non-allergic children with chronic nasal obstruction and associated symptoms (rhinorrhea, sneezing and nasal itchiness) were retrospectively selected. All patients had been submitted to a clinical history, pediatric evaluation, anterior rhinoscopy and fiberendoscopy, rhinomanometry and nasal cytology. ResultsNon-allergic rhinitis with neutrophils was present in 46 (40.4%) children, non-allergic rhinitis with eosinophils in 53 (46.5%), non-allergic rhinitis with mast-cells in 12 (10.5%) and non-allergic rhinitis with both eosinophils and mast-cells in 3 (2.6%).Nasal obstruction was prevalent in non-allergic rhinitis with eosinophils and in non-allergic rhinitis with mast-cells patients (P<0.001) whereas rhinorrea and sneezing only in the form with eosinophils (P<0.0001). Nasal itching on the other hand was prevalent in the form with mast-cells (P<0.0003).Non-allergic rhinitis with eosinophils group showed a higher probability of asthma (P<0.02) and respiratory sleep disorders (P<0.04). ConclusionsIn the pediatric age group the most frequent forms of non-allergic rhinitis are those with eosinophils or with neutrophils. A diagnosis of non-allergic rhinitis with eosinophils in children presumes more severe symptoms and a higher incidence of pulmonary disease and roncopathy.

The changes of IL-17 and inflammatory corpuscle percentage in the induced phlegm from the children with bronchial asthma

Objective To explore the changes of IL-17 and neutrophils,eosinophils percentage in the induced phlegm from the children with different severity bronchial asthma.Methods Forty children with acute asthma were divided into two groups according to the severity of asthma:medium or severe group(n =16) and light group( n =24 ).Twenty normal children were chosen in the same stage as control group.The IL-17 content and the percentage of neutrophils and eosinophils were compared.Results The contents of IL-17 in the medium or severe group,light group and control group were(1.096 ±0.664) ng/L,(0.474 ±0.240) ng/L and(0.227 ±0.360 ) ng/L respectively.The percentage of neutrophils were ( 55.359 ± 12.486 ) ％,( 44.476 ± 17.708 ) ％ and ( 36.493 ± 12.470 ) ％ respectively.The percentage of eosinophils were ( 1.252 ± 2.025 ) ％,(4.107 ± 3.234) ％and (1.409 ± 3.480) ％ respectively.There were significant differences in three groups ( P ＜ 0.05 ).There was significant positive correlation between IL-17 content and percentage of neutrophils in the medium or severe group( r =0.740,P =0.049 ).There was negative correlation in the light group ( r =- 0.764,P =0.000 ).Conclusion There was different among IL-17 content and percentage of neutrophils,eosinophils in children of different groups.The study showed that IL-17 was involved in the potential pathogenesis of asthma. Key words: Bronchial asthma; Induced phlegm ; Interleukin17; Inflammatory cells

Analysis of serum total IgE, specific IgE and eosinophils in children with acute and chronic urticaria

Increased IgE and eosinophil levels are frequently observed in cutaneous inflammation and are thought to provoke the occurrence of urticaria. However, the relationship of these factors with the disease duration of urticaria remains unclear. The aim of this study was to compare serum total IgE levels, specific IgE sensitization rates and eosinophil percentages between acute and chronic urticaria in children. A total of 165 patients (104 with acute and 61 with chronic urticaria) from a tertiary referral hospital were enrolled in this study. Serum levels of total IgE, prevalence of sensitization to food and aeroallergens and blood eosinophil percentages were compared by the disease duration of urticaria. There were no statistical differences in total IgE production, positive sensitization to specific allergens and eosinophil percentages between the patients with acute and chronic urticaria. There is a higher prevalence of sensitization to aeroallergens than food allergens in children with urticaria. In terms of gender, males had significantly higher serum IgE levels than females. Boys potentially have a higher serum IgE expression than girls children with urticaria. IgE levels and eosinophil percentages are not good indicators for a prolonged course of urticaria. The prevalence of sensitization to aeroallergens was significantly higher than that of food allergens in children with urticaria. Routine laboratory analysis for common allergens is not appropriate, and it could be a feasible approach to detect a predilection for atopy when respiratory infections are causative factors of urticaria occurrence.

194 Influence of Montelukast on the State of Eosinophil Activation in Asthmatic Children

BackgroundEosinophils play an important role in inflammation asthma. In asthma, the leukotrienes are implicated in pathophysiological mechanisms. The antileukotriene montelukast inhibits proinflammatory cytokines and decreases half-life of eosinophils. However, the influence of montelukast on the activation of eosinophils is not clear yet. Therefore, the objective of this work was to evaluate the effect of montelukast on the state of activation of eosinophils in children with persistent asthma.MethodsIt was selected 83 asthmatic children, from 2 to 18 years old, that were randomly assigned to treatment with montelukast or placebo for 12 weeks and 10 healthy control children. Asthma severity was assessed by the criteria of Global Initiative for Asthma (GINA, 2010). Peripheral blood was taken from children after parent's informed consent. The activation of eosinophils was assessed by morphological parameters after adherence to slide, before and after 12 weeks of treatment with montelukast or placebo. The following morphological parameters were evaluated: normal eosinophils, spreading, rounding, presence of localized and generalized pseudopods, release of small, moderate and large quantity of granules, cytoplasmatic vacuoles, cluster of free eosinophils granules, cell degeneration and cell communication.ResultsThe number of eosinophils with normal feature in peripheral blood showed an inverse correlation with the severity of asthma, while the emission of widespread pseudopods and isolated granules showed positive correlation with the severity of asthma (P < 0.0001; Spearman correlation test). Montelukast was able to reduce the number of eosinophils in peripheral blood from 513 cells/mm3 to 485 cells/mm3 (P = 0.017, paired t test) after treatment, and to increase the proportion of eosinophils with normal feature from 45% to 51% (P = 0.03; Wilcoxon test). The drug was also able to decrease the median of eosinophils with rounded feature (1.5 versus 0) and that releasing free eosinophil granules (2.25 versus 0.5) after 12 weeks of treatment compared to placebo, respectively (P = 0.005; Mann Whitney test).ConclusionsOur data showed, for the first time, that montelukast is able to modify the activation of eosinophils correlated with clinical severity. Parameters of eosinophil activation could be used to the follow up of response to montelukast treatment of asthma individuals.

Prevalence of inhaled antigen sensitization and nasal eosinophils in Japanese children under two years old

Objective The increasingly younger age of onset of allergic rhinitis (AR) has recently become a problem. This study examined the prevalence of inhaled antigen sensitization and nasal eosinophils in children younger than two years old, with measurement of the serum concentrations of aeroallergen-specific IgE antibodies to house dust mites, cat fur, and Japanese cedar pollen, measurement of nasal eosinophil counts, and a questionnaire administered to the children's parents. Methods The subjects were a group of healthy children undergoing 18-month infant health checks provided by the local government, and sick children younger than two years old at the pediatric hospital. Results Among 408 healthy infants, 44 (10.7%) had antigen-specific IgE antibodies, 29 (7.1%) had nasal eosinophils, and eight (2.0%) had both specific IgE antibodies and nasal eosinophils. Nasal assessment revealed that 125 children had rhinorrhea. Of the infants who showed both sensitization to antigens and nasal eosinophils, six (1.5%) had confirmed rhinorrhea. Among 186 sick children younger than two years old at the pediatric hospital, aeroallergen-specific IgE antibodies were detected in five (2.6%). The presence of nasal eosinophils was confirmed in six children (3.2%), which percentage was smaller than that of the healthy group. No infant had either sensitization to antigens or nasal eosinophils. Conclusion The findings described above indicate that the minimum prevalence of AR might be 1.5% in 18-month-old children and that around 10% of affected children have aeroallergen-specific IgE antibodies in Japan. The incidence of AR in young children might increase further.

An Antibody Against IL-5 Reduces Numbers of Esophageal Intraepithelial Eosinophils in Children With Eosinophilic Esophagitis

The role of interleukin (IL)-5 in the pathogenesis of eosinophilic esophagitis (EoE) has been established in animal models; anti-IL-5 therapy has been reported to be effective in adults. We investigated whether IL-5 has a role in accumulation of esophageal eosinophils in children with EoE and whether therapy with mepolizumab, an antibody against IL-5, reduces the number of esophageal intraepithelial eosinophils in children with EoE. We performed an international, multicenter, double-blind, randomized, prospective study of 59 children with EoE, defined as baseline peak count of esophageal intraepithelial eosinophils of ≥ 20 in at least 1 high-power field (hpf). Patients received an infusion every 4 weeks (a total of 3 infusions) of 0.55, 2.5, or 10 mg/kg mepolizumab. No placebo group was used. Baseline peak and mean esophageal intraepithelial eosinophil counts were (mean ± SE) 122.5 ± 8.78 and 39.1 ± 3.63 per hpf, respectively. Four weeks after the third infusion, peak eosinophil counts were <5 per hpf in 5 of 57 children (8.8%); we did not observe differences among groups given different doses of mepolizumab. Reduced peak and mean eosinophil counts, to <20 per hpf, were observed in 18 of 57 (31.6%) and 51 of 57 (89.5%) children, respectively. Peak and mean esophageal intraepithelial eosinophil counts decreased significantly to 40.2 ± 5.17 and 9.3 ± 1.25 per hpf, respectively (P < .0001). An analysis to evaluate predictors of response associated a higher mean baseline esophageal intraepithelial eosinophil count with a greater reduction in mean count (P < .0001). IL-5 is involved in the pathogenesis of EoE in children. Mepolizumab, an antibody against IL-5, reduces esophageal eosinophilic inflammation in these patients.

Utility of an Elemental Diet in Adult Eosinophilic Esophagitis

Background: Data suggests that food is a primary trigger for the development of esophageal eosinophilia in children. Six food elimination diets are effective in adults, but the efficacy of an elemental diet in adult patients with eosinophilic esophagitis (EoE) has not been reported. Aims: To determine whether adult patients with EoE exhibit clinical and histologic improvement to an elemental diet compared to their normal diet. To determine the time of response of esophageal eosinophilia to elemental diet. Methods: EoE was diagnosed by esophageal obstructive symptoms (dysphagia, chest pain, food impaction, heartburn) and esophageal biopsies demonstrating >20 eosinophils/HPF in the setting of high dose acid suppression. All subjects underwent a second EGD/biopsies 2-3 weeks after their initial EGD/biopsies to confirm stability of disease while maintaining their normal diet. After the 2nd EGD/biopsies, all patients were started on an elemental diet (Elecare, Abbott Laboratories, Columbus, Ohio) and underwent a 3d EGD/biopsies after 2 weeks of Elecare. If subjects did not completely respond (eos 20/HPF at 2nd EGD) and completed at least 2 weeks of the Elecare diet. Five subjects dropped out of the trial after 2 weeks (2 due to poor tolerance of the diet, 3 for personal reasons). One patient responded completely at 2 weeks (1 eos/hpf). The remaining 20 patients completed a 4 week trial of Elecare. Eosinophil counts did not vary significantly between the 1st and 2nd EGD's (distal 44 to 43 eos/HPF, proximal 33 to 40 eos/HPF respectively, p =0.43, p=0.43). Dramatic decreases in eosinophils were seen at 2 weeks after starting Elecare (average distal 13 eos/HPF and proximal 14 eos/HPF, p <0.001 for both) and decreases correlated with an overall clinical response to therapy at 4 weeks. Response continued less profoundly between 2 and 4 weeks on Elecare (distal 11 eos/HPF and proximal 8 eos/HPF). 11/21 (52%) responded with counts less than 8 eos/HPF by week 4. Discussion: Elemental diet resulted in marked improvement in esophageal eosinophilia in a substantial number of adults with EoE. Histologic response occurs within 2 weeks of starting the elemental diet and profound decreases in eosinophilia at 2 weeks are maintained at 4 weeks on diet. Elemental diets are useful in the treatment of EoE to provide rapid relief of symptoms and tissue eosinophilia.

Esophageal Eosinophilia and Wall Distensibility in Eosinophilic Esophagitis (EoE) Before and After Treatment: Preliminary Outcomes

Background: Data suggests that food is a primary trigger for the development of esophageal eosinophilia in children. Six food elimination diets are effective in adults, but the efficacy of an elemental diet in adult patients with eosinophilic esophagitis (EoE) has not been reported. Aims: To determine whether adult patients with EoE exhibit clinical and histologic improvement to an elemental diet compared to their normal diet. To determine the time of response of esophageal eosinophilia to elemental diet. Methods: EoE was diagnosed by esophageal obstructive symptoms (dysphagia, chest pain, food impaction, heartburn) and esophageal biopsies demonstrating >20 eosinophils/HPF in the setting of high dose acid suppression. All subjects underwent a second EGD/biopsies 2-3 weeks after their initial EGD/biopsies to confirm stability of disease while maintaining their normal diet. After the 2nd EGD/biopsies, all patients were started on an elemental diet (Elecare, Abbott Laboratories, Columbus, Ohio) and underwent a 3d EGD/biopsies after 2 weeks of Elecare. If subjects did not completely respond (eos 20/HPF at 2nd EGD) and completed at least 2 weeks of the Elecare diet. Five subjects dropped out of the trial after 2 weeks (2 due to poor tolerance of the diet, 3 for personal reasons). One patient responded completely at 2 weeks (1 eos/hpf). The remaining 20 patients completed a 4 week trial of Elecare. Eosinophil counts did not vary significantly between the 1st and 2nd EGD's (distal 44 to 43 eos/HPF, proximal 33 to 40 eos/HPF respectively, p =0.43, p=0.43). Dramatic decreases in eosinophils were seen at 2 weeks after starting Elecare (average distal 13 eos/HPF and proximal 14 eos/HPF, p <0.001 for both) and decreases correlated with an overall clinical response to therapy at 4 weeks. Response continued less profoundly between 2 and 4 weeks on Elecare (distal 11 eos/HPF and proximal 8 eos/HPF). 11/21 (52%) responded with counts less than 8 eos/HPF by week 4. Discussion: Elemental diet resulted in marked improvement in esophageal eosinophilia in a substantial number of adults with EoE. Histologic response occurs within 2 weeks of starting the elemental diet and profound decreases in eosinophilia at 2 weeks are maintained at 4 weeks on diet. Elemental diets are useful in the treatment of EoE to provide rapid relief of symptoms and tissue eosinophilia.

Correlation of Food Hypersensitivity with Degree of Tissue Eosinophilia in Children with Eosinophilic Esophagitis (EE)

RATIONALE: The role of food atopy in pathogenesis of EE and dietary intervention in treatment of EE have been debated. This study was conducted to determine any correlation of severity of tissue eosinophilia and the degree of hypersensitivity to foods commonly eliminated in treatment.

Defining Eosinophilic Colitis in Children: Insights From a Retrospective Case Series

Although it is a well-described syndrome in infants, eosinophilic colitis is a loosely defined and poorly understood diagnosis in older children. The aims of this case series were to characterise colonic eosinophilia in children and to determine whether it represents a distinct clinicopathological condition. We retrospectively reviewed symptomatic children older than 12 months with the principal diagnosis of colonic eosinophilia who presented between January 2000 and February 2007 (n = 38) and a further 10 children whose colonic biopsies were reported as histologically normal. The eosinophil density in all available gastrointestinal biopsies (n = 620) of these children was determined using a validated quantitative morphometric method. Patients were subdivided according to mean colonic eosinophil levels into 3 groups (marked, moderate, or minimal colonic eosinophilia). The following patient information was obtained and compared among patient groups: symptoms prompting endoscopy, atopic history, outcome, serum C-reactive protein and total immunoglobulin E (IgE) levels, erythrocyte sedimentation rate, blood eosinophil count, and endoscopic findings. In all 3 patient groups, there was a colonic gradient of decreasing eosinophil density from caecum to rectum. Upper gastrointestinal tract biopsies did not exhibit eosinophilia. Although a significant association (P = 0.03) between abnormal total IgE levels and moderate or severe colonic eosinophilia was found, there was no significant difference (P > 0.05) in other patient characteristics. Furthermore, follow-up data did not show a consistent relation between eosinophil density and progression of symptoms. We find no association between "eosinophilic colitis," defined as a histologically demonstrated marked colonic eosinophilia, and symptoms, history of atopy, inflammatory markers, or clinical outcome.

Montelukast in the treatment of duodenal eosinophilia in children with dyspepsia: Effect on eosinophil density and activation in relation to pharmacokinetics

BackgroundWe have previously demonstrated the clinical efficacy of montelukast in a randomized double-blind controlled cross-over trial in patients with dyspepsia in association with duodenal eosinophilia. The mechanism of this clinical response is unknown but could involve a decrease in eosinophil density or activation.MethodsTwenty-four dyspeptic patients 8–17 years of age underwent initial blood sampling and endoscopy with biopsy. Eighteen of these patients had elevated duodenal eosinophil density and underwent repeat blood sampling and endoscopy following 21 days of therapy with montelukast (10 mg/day). The following were determined: global clinical response on a 5-point Lickert-type scale, eosinophil density utilizing H & E staining, eosinophil activation determined by degranulation indices on electron microscopy, and serum cytokine concentrations. On day 21, pharmacokinetics and duodenal mucosal drug concentrations were determined.ResultsEighty-three percent of the patients had a positive clinical response to montelukast with regard to relief of pain with 50% having a complete or nearly complete clinical response. The response was unrelated to systemic drug exposure or to mucosal drug concentration. Other than a mild decrease in eosinophil density in the second portion of the duodenum, there were no significant changes in eosinophil density, eosinophil activation, or serum cytokine concentrations following treatment with montelukast. Pre-treatment TNF-α concentration was negatively correlated with clinical response.ConclusionThe short-term clinical response to montelukast does not appear to result from changes in eosinophil density or activation. Whether the effect is mediated through specific mediators or non-inflammatory cells such as enteric nerves remains to be determined.Trial RegistrationClinicalTrials.gov; NCT00148603