Peripheral Blood Absolute Eosinophil Count Research Articles

Suplatast tosilate reduces peripheral blood eosinophil levels in patients with eosinophilia: A real-world retrospective study

IntroductionEosinophilia is a rare disease characterized by an increase in eosinophils. Suplatast tosilate is a selective Th2 cytokine inhibitor that can reduce eosinophils. There is currently a lack of clinical studies of suplatast tosilate in the treatment of eosinophilia. Research objectiveTo explore whether suplatast tosilate can reduce blood eosinophil levels in eosinophilia and the factors that might influence the improvement. MethodsA real-world retrospective study of 20 patients with eosinophilia was conducted using electronic medical record information. The main outcome measure was the difference in peripheral blood absolute eosinophil count (AEC) and percentage (EOS%) before suplatast tosilate (baseline) and the lowest AEC during the 1-year period of suplatast tosilate treatment (post-treatment). Data on age, gender, disease duration, involved organs, and concomitant medication were collected, and subgroup analysis and linear regression analysis were performed. ResultsSubjects were predominantly male, with a mean age of 33 years and a disease duration of approximately 30 months. After treatment with suplatast tosilate, the patient's AEC (p ​= ​0.029) and EOS% (p ​= ​0.016) significantly decreased. The decline in eosinophils was more pronounced in patients who were male, age <33 years, disease duration <30 months and gastrointestinal system involvement. In addition, the shorter the course of the disease, the greater the relative decrease in eosinophils after suplatast tosilate treatment (β ​= ​−0.018, p ​< ​0.001). ConclusionsSuplatast tosilate is effective in reducing peripheral blood eosinophil levels in patients with eosinophilia. Large-scale prospective cohort studies are needed for further confirmation.

Eosinophil count in COPD - Do we need different cut-offs for our population?

Background: Blood peripheral Eosinophil count in COPD patients is increasingly being considered as a biomarker in COPD and is now being included in major guidelines to guide treatment, particularly in the use of inhaled corticosteroids. Objective: To estimate the peripheral blood Absolute Eosinophil Count (AEC) in COPD patients attending the Pulmonary Medicine OPD, Government Medical College, Trivandrum. Methodology: A cross-sectional study was done recruiting 145 COPD patients consecutively. Patients were interviewed with a structured questionnaire and their AEC was calculated by the standard haematological method. Analysis was done with EpiInfo version 7. Results: 145 Patients with COPD were recruited for the study and 112 MDR TB patients served as control. The mean AEC in COPD patients was 490 ±641. The AEC was significantly higher in the COPD group compared to another patient population in the same hospital represented by the Multi-Drug Resistant Tuberculosis (MDR TB) group (median of 469 for COPD vs. 231 for MDR TB;p value&lt; 0.001). Among the physiological variables, a higher BMI was associated with a greater Eosinophil count. Conclusion: 64.83% of COPD patients had an AEC greater than 300, which was the cut off recommended by GOLD guidelines for the use of inhaled cortico-steroids. Using the same value as in Western guidelines can lead to a rather liberal use of steroids in the Indian population, with its accompanying side effects.

Prognostic impact of eosinophils in peripheral blood and tumor site in patients with esophageal squamous cell carcinoma treated with concurrent chemoradiotherapy

To date, no effective biological markers have been identified for predicting the prognosis of esophageal cancer patients. Recent studies have shown that eosinophils are independent prognostic factors in some cancers. This study aimed to identify the prognostic impact of eosinophils in esophageal squamous cell carcinoma patients treated with concurrent chemoradiotherapy (CCRT).This study enrolled 136 patients who received CCRT for locally advanced unresectable esophageal squamous cell carcinoma (ESCC). We evaluated the survival time and clinical pathological characteristics of eosinophils. The Kaplan–Meier method was used to estimate survival data. The log-rank test was used for univariate analysis and the Cox proportional hazards regression model was used to conduct a multivariate analysis.Kaplan–Meier analysis revealed that high eosinophil infiltration correlated with better overall survival (OS) (P = .008) and better progression-free survival (PFS) (P = .015). The increase in absolute eosinophil count after CCRT also enhanced OS (P = .005) and PFS (P = .007). The PFS and OS in patients with high blood eosinophil count before CCRT (>2%) was better than those with low blood eosinophil count(<2%) (P = .006 and P = .001, respectively). Additionally, the multivariate analysis revealed that disease stage and high eosinophil infiltration, increased peripheral blood absolute eosinophil count after CCRT, and high peripheral blood eosinophil count before CCRT were independent prognostic indicators.High eosinophil count of tumor site, increased peripheral blood absolute eosinophil count after CCRT, and high peripheral blood eosinophil count before CCRT are favorable prognostic factors for patients with ESCC treated with CCRT.

Choice of biologics in asthma endotypes.

The aim of this study was to highlight the phenotypes and endotypes of asthma as a tool for selection of the Food and Drug Administration approved biologic therapies. An evolving concept of asthma has led to the identification of distinct phenotypes and endotypes in this disease. Asthma endotypes are defined as the biological mechanism and are often categorized as T2-high and T2-low based on the influence of T helper type 2 (T2) cells and type 2 cytokines, including interleukin (IL)-4, IL-5, IL-9 and IL-13. Biomarkers such as peripheral blood absolute eosinophil count, total IgE, specific IgE and fractional exhaled nitric oxide may be used as indicators of asthma endotypes and help predict response to biologic therapies. There are currently five biologic therapies approved as a treatment option for T2-high asthma: omalizumab, benralizumab, mepolizumab, reslizumab and dupilumab. Here, we explore the current understandings of asthma endotypes and review their associated phenotypes. We provide practical and evidence-based guidance for clinicians considering a biologic for asthma add-on maintenance therapy.

An Approach to the Evaluation of Persistent Hypereosinophilia in Pediatric Patients

Hypereosinophilia (HE) is currently defined by a peripheral blood absolute eosinophil count (AEC) of ≥1,500 cells/microL. Although mild blood eosinophilia (AEC 500–1,500 cells/microL) is observed relatively frequently within the pediatric population, persistent HE is uncommon and should prompt additional clinical evaluation. While the clinical manifestations and underlying etiologies of HE in adults have been well-characterized, there is a paucity of data on HE in children. Limited evidence suggests that many similarities between adult and pediatric HE likely exist, but some important differences remain between these populations. The evaluation of HE in children can be challenging given the broad differential diagnosis, which includes primary hematologic disorders and secondary eosinophilia in which the increased eosinophil levels are propagated by disease states that promote eosinophil production and survival. On the basis of the underlying etiology, clinical manifestations can range from benign, self-resolving elevations in the AEC to life-threatening disorders with the potential for significant end-organ damage. Given the broad differential diagnosis of HE, it remains essential to systematically approach the evaluation of unexplained HE in children. This review will discuss the differential diagnosis for pediatric HE, highlighting etiologies that are more prevalent within the pediatric population. Additionally, a summary of the epidemiology of pediatric HE will be presented, with focus on some of the differences that exist between pediatric and adult HE. Finally, a directed approach to the diagnostic evaluation of children with HE will be discussed.

Effects of low-dose clarithromycin added to fluticasone on inflammatory markers and pulmonary function among children with asthma: A randomized clinical trial.

Background:Macrolides exert anti-inflammatory and immunomodulatory effects beyond their purely antibacterial action, as demonstrated by several bronchial inflammatory disorders, including asthma.Methods:Fifty-eight children with newly diagnosed mild persistent asthma were selected by using the Global Initiative for Asthma guidelines and were randomly divided into the study (group I) (n = 36) and control (group II) (n = 22) groups. Mycoplasma pneumonia-specific immunoglobulin G and -specific immunoglobulin M antibody levels of each participant were measured by enzyme-linked immunosorbent assay. Clarithromycin 5 mg/kg daily and placebo were given to groups I and II, respectively, for 4 weeks. All of the children had maintenance inhaled corticosteroid (fluticasone propionate, one puff twice [50 μg/puff] daily). Forced expiratory volume in 1 second, forced expiratory flow at 25–75% of the pulmonary volume, exhaled nitric oxide value, total IgE level, absolute eosinophil count, and eosinophilic cation protein value were measured at baseline and at the end of the treatment.Results:There are significantly increased forced expiratory volume in 1 second and forced expiratory flow at 25–75% of the pulmonary volume levels and decreased exhaled nitric oxide values after the 4-week clarithromycin treatment. The study group also had a decreased peripheral blood absolute eosinophil count and eosinophilic cation protein level, but not for the total IgE level, after the treatment.Conclusion:Four weeks of sub-antimicrobial doses of clarithromycin may improve pulmonary function and decrease eosinophilic inflammation in children with asthma.

Potential of Blood Eosinophils, Eosinophil-Derived Neurotoxin, and Eotaxin-3 as Biomarkers of Eosinophilic Esophagitis

Eosinophilic esophagitis (EE) is an increasingly recognized disorder characterized by eosinophilic inflammation of the esophageal mucosa, and typically requires serial invasive endoscopic biopsy examinations to document the characteristic histologic features of the disorder. The aim of this study was to identify noninvasive biomarkers that correlated with disease activity and response to treatment as measured by esophageal eosinophilia. A prospective, cross-sectional analysis was performed on 47 pediatric patients undergoing endoscopic evaluation of possible EE. Blood samples were collected for measurement of peripheral blood absolute eosinophil count (AEC) and levels of eosinophil-derived neurotoxin (EDN), eotaxin-1, -2, and -3, and interleukin-5. Stool samples were collected for measurement of EDN. Biomarker levels were correlated with esophageal eosinophil density, and differences in biomarker levels based on disease activity and treatment were determined. AEC, plasma EDN levels, and eotaxin-3 levels significantly correlated with esophageal eosinophil density (AEC: r = 0.56, P < .0001; EDN: r = 0.54, P < .0001; eotaxin-3: r = 0.32, P = .04), and were increased in patients with active EE vs controls (AEC: 440 vs 140 eosinophils/muL, P < .05; EDN: 50.3 vs 31.1 ng/mL, P = .01; eotaxin-3: 37.7 vs 11.5 pg/mL, P = .01). Cut-off values were established to maximize the sensitivity, specificity, and predictive values of these biomarkers alone and in combination. Eotaxin-1, eotaxin-2, interleukin-5, and fecal EDN levels did not correlate with esophageal eosinophil density, and were not increased in active EE vs controls or those with inactive EE. These data show that blood levels of AEC, EDN, and eotaxin-3 may have value as noninvasive biomarkers for monitoring EE.

Increased plasma eotaxin in atopic dermatitis and acute urticaria in infants and children.

The previously reported eotaxin overexpression in the lesional skin of atopic dermatitis (AD) led us to the assumption that circulating levels of eotaxin may be elevated too. We sought to investigate the plasma expression of eotaxin in children with skin allergy in relation to clinical activity and type of lesions. Plasma eotaxin was assayed in 78 infants and children, of whom 16 had AD, 19 had acute urticaria (AU), and 43 were healthy matched subjects. Seven children in the group of AU were resampled for plasma eotaxin after clinical remission. The plasma eotaxin levels in AD (median=158 pg/ml, mean [SD]=168 [61] pg/ml) were significantly higher than the control values (median=60 pg/ml, mean [SD]=59.5 [18.5] pg/ml). Not only did patients with AU demonstrate elevated plasma eotaxin levels (median=126 pg/ml, mean [SD]=124 [33] pg/ml), but also a significant decline occurred on follow-up. The coexistence of angioedema with AU did not cause any further increase in plasma eotaxin expression. Plasma eotaxin levels were significantly higher in AD than in AU, probably reflecting the chronic nature of eczematous AD lesions. The plasma eotaxin levels did not correlate with serum total IgE, peripheral blood absolute eosinophil count, or age of the patients. However, there was a positive correlation between age and plasma eotaxin in the control group. Our findings imply that circulating levels of eotaxin increase in AD and during flares of AU, probably to serve in the recruitment and activation of eosinophils. It may also represent a biomarker of lesional activity.

Serum IgE in Dermatitis and Dermatosis

Serum IgE values from 497 patients with various forms of dermatitis, dermatosis, and tinea pedis were analyzed statistically and compared with values from 95 normal controls. The median and geometric mean values were significantly elevated (except in acne without atopy, lichen planus, and tinea pedis), even after exclusion of patients with a history of atopy or of cutaneous reaction to food or drugs. Serum IgE levels and atopic dermatitis have a close correlation. A modest positive correlation (p approximately equal to .05) appeared between the log serum IgE level and peripheral blood absolute eosinophil count in 80 cases of atopic dermatitis. A unique group of adult nonatopic patients had acquired generalized dermatitis and markedly elevated serum IgE levels (greater than 12,000 ng/ml). Our results suggest that, in most common dermatologic disorders, elevated serum IgE is a secondary phenomenon rather than a primary causative factor.