Serum Eosinophil Count Research Articles

Allergic Asthma in the Era of Personalized Medicine.

Allergic asthma is the most common asthma phenotype and is characterized by IgE sensitization to airborne allergens and subsequent typical asthmatic symptoms after exposure. A form of type 2 (T2) airway inflammation underlies allergic asthma. It usually arises in childhood and is accompanied by multimorbidity presenting with the occurrence of other atopic diseases, such as atopic dermatitis and allergic rhinitis. Diagnosis of the allergic endotype is based on in vivo (skin prick tests) and/or in vitro (allergen-specific IgE levels, component-resolved diagnosis (CRD)) documentation of allergic sensitization. Biomarkers identifying patients with allergic asthma include total immunoglobulin E (IgE) levels, fractional exhaled nitric oxide (FeNO) and serum eosinophil counts. The treatment of allergic asthma is a complex procedure and requires a patient-tailored approach. Besides environmental control involving allergen avoidance measurements and cornerstone pharmacological interventions based on inhaled drugs, allergen-specific immunotherapy (AIT) and biologics are now at the forefront when it comes to personalized management of asthma. The current review aims to shed light on the distinct phenotype of allergic asthma, ranging over its current definition, clinical characteristics, pathophysiology and biomarkers, as well as its treatment options in the era of precision medicine.

Association of Soil-Transmitted Helminths Infection with Total Serum Immunoglobulin E Levels and Total Eosinophils in Elementary School Students in Medan

BACKGROUND: Soil-transmitted helminths infection is widespread in tropical and subtropical areas. More than 267 million preschool-aged children and more than 568 million school-age children live in areas where this parasite is transmitted intensively and requires treatment and prevention. People at risk are preschool children, school-aged children, reproductive age women, and adults in certain high-risk occupations, such as tea pickers or miners. Worm infections often infect elementary schoolchildren because at this time, children have many activities and are often in direct contact with a dirty environment so that it can cause children not to pay attention to personal hygiene. AIM: This study aimed to determine the association of STH infection with total serum IgE levels and eosinophil counts in elementary school students in Medan. METHODS: This cross-sectional study was conducted on 65 elementary school students at Medan orphanage who met inclusion and exclusion criteria. Examination of STH infection was carried out using Kato-Katz method, and blood tests were performed to assess total serum IgE and blood eosinophils counts. Univariate and bivariate analysis was performed to determine the association of STH infection with total serum IgE levels and eosinophil counts in these students using Pearson correlation test and Chi-square. RESULTS: Of the 65 elementary school students in the orphanage who were willing to have their routine blood and feces checked, 36 boys (55.3%) and 29 girls (44.6%), 39 children were infected with STH (60%). The most common infections were Ascaris lumbricoides (26.1%), Trichuris trichiura (18.4%), and mixed infections (15.3%) with an average of mild infection intensity. The results of the analysis showed that there was no significant association between STH infection and eosinophils counts (p = 0.582, 95% confidence interval, OR 1.3). In addition, there was also no significant association of STH infection with total serum IgE levels (p = 0.883, 95% confidence interval, OR 63.6). CONCLUSION: In this study, there was no association between STH infection with eosinophils counts and total serum immunoglobulin E levels in elementary school students in Medan.

Effectiveness and safety of electric heating moxibustion for perennial allergic rhinitis: A pilot, randomized, assessor-blind trial

BackgroundThe prevalence of allergic rhinitis (AR), an inflammatory disease, is gradually increasing. Studies have reported that moxibustion is effective for treating AR. Electric heating moxibustion (EM) was developed to offer adaptable heat stimulation without the generation of smoke. ObjectivesThe objective of this study was to examine the possibility of EM in treating perennial allergic rhinitis (PAR) and to assess the feasibility of using this technique on a larger scale by comparing EM with acupuncture (AC). DesignA randomized pilot study was conducted on 40 patients with PAR. Patients were randomly assigned to one of two treatment groups: EM or AC. The primary outcome measure was the change in the total nasal symptom score (TNSS) between before and after treatment. The secondary outcome measures were the changes in the rhinoconjunctivitis quality of life questionnaire (RQLQ), nasal endoscopy index for pattern identification, pattern identification questionnaire for AR, total serum immunoglobulin E (IgE), eosinophil count, and adverse effects (AEs). ResultsThe results showed a statistically significant improvement in mean TNSS and RQLQ scores in both groups (p < 0.05), but no significant difference between the two groups. However, mean changes in itching and sneezing TNSS were significantly higher in the AC group. There was no significant difference in total serum IgE or eosinophil count before versus after treatment, nor was there any significant difference of three pattern subgroups between the two groups in the mean TNSS change. While the AC group reported two treatment-related AEs, there were no treatment-related AEs in the EM group. ConclusionThis trial provides evidence that EM isa safe alternative treatment for patients with PAR. Trial registrationClinicalTrials.gov, NCT03342105. Registered on 14 November 2017.

Predictors of Response to Oral Medications and Low-Histamine Diet in Patients with Chronic Urticaria.

Background Chronic urticaria (CU) is comprised of diverse phenotypes, and thus, a shift towards a precision medical approach is warranted in its management. Methods This study enrolled 78 patients with CU. Serum erythrocyte sedimentation rate, hemoglobin, hematocrit, eosinophil count, IgE, antinuclear antibody (ANA), and serum diamine oxidase (DAO) levels of the patients were measured and were compared according to the patient's response to second-generation antihistamines (sgAH), corticosteroids, leukotriene receptor antagonist (LTRA), H2 blockers, and low-histamine diet. Results Age- and sex-adjusted logistic regression analysis showed that patients with duration of CU > 3 years (adjusted odd ratio [aOR] = 4.39) and a DAO level < 10 U/mL (aOR = 3.90) were significantly associated with a good sgAH response. Age > 50 years (aOR = 0.02), duration of chronic urticaria > 3 years (aOR =0.06), and an ANA titer ≥ 1 : 80 (aOR = 0.03) were significantly and inversely associated with corticosteroid response. A low-histamine diet response was significantly associated with LTRA response (aOR = 67.29). In addition, a DAO level < 5.4 U/mL (aOR = 71.95) was significantly associated with H2 blocker response. Furthermore, concomitant angioedema (aOR = 10.56), multiple food triggers (aOR = 11.69), and a DAO level < 5.4 U/mL (aOR = 3.78) were significantly associated with a low-histamine diet response. Conversely, dermatographic urticaria and a hematocrit level < 36% were significantly and inversely associated with low-histamine diet response. Conclusions Several promising biomarkers were identified in this study to predict the efficacy of chronic urticaria treatment. DAO could be a novel biomarker for predicting the efficacy not only of dietary intervention but also for antagonists of H1 and H2 receptors.

Biologic Responses to House Dust Mite Exposure in the Environmental Exposure Unit.

Introduction: Allergic rhinitis (AR) is an inflammatory disease of the nasal mucosa that can be modeled using Controlled Allergen Exposure Facilities (CACF). Recently, we clinically validated the house dust mite (HDM) Environmental Exposure Unit (EEU) facility. In the current study, we aimed to assess biological responses in the blood following HDM exposure in the HDM-EEU.Methods: Fifty-five participants passed a screening visit, where they provided consent and completed a skin prick test (SPT), then attended a modest or higher HDM exposure session. Baseline and post-exposure blood samples were collected. Complete blood counts with differentials were measured, and isolated serum was used to determine Dermatophagoides farinae- and Dermatophagoides pteronyssinus-specific IgE (sIgE) and cytokine concentrations (IL-4, IL-5, IL-6, IL-10, IL-13, TNF-α).Results: HDM-allergic participants had significantly greater SPT wheal sizes than healthy controls. sIgE concentrations were significantly greater in allergic participants, with a strong correlation between Dermatophagoides farinae and Dermatophagoides pteronyssinus. Serum eosinophil counts were significantly decreased post-exposure for allergic participants. White blood cell, neutrophil, and lymphocyte counts were significantly increased for both allergic and non-allergic participants post-exposure. Serum IL-13 concentrations were significantly reduced post-exposure in allergics while TNF-α was significantly reduced in non-allergics.Conclusion: The HDM-EEU is a useful model for investigating biologic mechanisms of HDM-induced AR. Allergic participants produced measurable biological changes compared to healthy controls following allergen exposure, specifically with serum expression of eosinophils and related markers, namely IL-5, which promotes the proliferation and differentiation of eosinophils, and IL-13, a cytokine released by eosinophils. The exact mechanisms at play require further investigation.

IL1RL1 single nucleotide polymorphisms are associated with asthma in the Iranian population

Asthma is a chronic and multifactorial disease which is known to result from environmental and genetic factors. Interleukin 1 receptor-like 1 (IL1RL1) is a receptor, which promotes inflammatory responses after binding to its ligand IL-33. Several studies have shown that IL1RL1 gene polymorphisms are related to susceptibility or protection to asthma. The objective of this study was to evaluate the association between two IL1RL1 single nucleotide polymorphisms (rs10208293 and rs1041973) and the risk of asthma in the Iranian population. We performed genotyping of the IL1RL1 SNPs in 126 adult asthmatics and 300 healthy controls using TaqMan genotyping assay. Moreover, total serum IgE level, eosinophil count, and skin prick test were accomplished. The results indicated that the AA genotype of rs10208293 was positively associated with asthma susceptibility (p=0.028). We did not find any association between rs1041973 and asthma. Overall, our findings indicate that rs10208293 has a positive association with asthma in the Iranian population.

Study of Eosinophil Count in Nasal and Peripheral Blood Smear Compare with Serum IgE Level in Children with Allergic Rhinitis

Introduction: Allergic rhinitis is one of the most common respiratory diseases. Patient with allergic rhinitis may have elevated level of serum IgE and eosinophil than normal person. Nasal smear eosinophil count is a simple test as well as noninvasive, can be repeated and inexpensive method for diagnosis of allergic rhinitis. Objective: To assess the eosinophil count in nasal smear as an alternative diagnostic test for children with allergic rhinitis. Methods: This cross-sectional study was conducted at the Department of Laboratory medicine and Paediatrics, BSMMU, Dhaka from September 2019 to August 2020 in 120 children (Age up to 18 years both sex). Diagnosed patients of allergic rhinitis according to ARIA-WHO guideline with history and clinical feature who fulfilled the inclusion criteria were selected as study population. After taking informed written consent blood and nasal secretion of allergic patient were drawn for serum IgE and eosinophil count. Nasal smears for eosinophil were stained using Giemsa stain and observed eosinophil under light microscope. Peripheral blood eosinophil count was estimated by hematology auto-analyzer (SYSMEX-XN 2000) and rechecked manually. The serum total IgE level was performed based on sandwich principle of ELISA. Results: The serum IgE level, nasal smear eosinophil count and blood eosinophil count were found increased with severity of allergic rhinitis, which was statistically significant (p&lt;0.001). Pearson’s correlation coefficient test revealed significant positive correlation between nasal smear eosinophil count with serum IgE (r= +.656, p&lt;0.001) and blood absolute eosinophil count (r= +.415, p&lt;0.001). Conclusion: Nasal smear eosinophil count was significantly raised alone with absolute eosinophil count and serum IgE level with the severity of allergic rhinitis in children.

Association between Vitamin D deficiency and lung function in asthma patients

Asthma is an inflammatory disorder, usually chronic, and is related to the hypersensitivity of the airways to allergens leading to dyspnoea, wheezing, cough and tightness in chest. Increased severity of asthma and poor control has been attributed to lower levels of Vitamin D levels. Blood was collected from 78 patients who were diagnosed with asthma and tested for Vitamin D levels eosinophil counts, IgE levels, and regular biochemical tests. All these patients underwent Asthma Control Test, Pulmonary Function tests for FEV1%, FVC%, FEV1/FVC%. : The serum eosinophil count, sputum eosinophil count and IgE levels were significantly higher in Vitamin D deficient patients compared to the sufficient patients. The most common severity of asthma among the patients was due to atopy as seen in 53.8% of the patients. In 39.6% of the patients who were Vit D deficient, the asthma was very severe as was the case in 8% of the Vit D sufficient people. The Forced expiratory volume, Forced vital capacity and FEV1/FVC1 was 92.69 ± 0.9 %, 91.3 ± 12.1% and 76.2 ± 8.7 in patients with deficient Vitamin D levels and 97.36 ± 1.1%, 99.1 ± 7.3% and 81.6 ± 13.1 in patients with sufficient Vit D levels respectively. There seems to be a strong association of Vitamin D levels and asthma among patients. High vitamin D levels are beneficial to the lung function and also slow the asthma exacerbations.

Successful treatment of corticosteroid-dependent drug reaction with eosinophilia and systemic symptoms with cyclosporine

BackgroundDrug reaction with eosinophilia and systemic symptoms (DRESS) is an intractable drug hypersensitivity disease with high mortality. The current standard treatment requires high-dose and long-term systemic corticosteroids, which may lead to adverse effects and intolerability of patients. ObjectiveTo evaluate the efficacy and safety of cyclosporine in patients with corticosteroid-dependent DRESS or intolerance to systemic corticosteroids. MethodsA retrospective review of 8 patients with corticosteroid-dependent DRESS who were treated with cyclosporine as an alternative treatment owing to suboptimal response to regular doses of systemic corticosteroids for at least 3 weeks, flare-ups when tapering corticosteroids, or experiencing intolerable adverse effects of corticosteroids. ResultsIn all 8 patients (4 women and 4 men; age range, 15-75 years), either intractable skin eruptions, persistent eosinophilia, or elevated liver function was noted after at least 3 weeks of treatment with systemic corticosteroids. The patients had marked cutaneous improvement and normalization of liver function and eosinophil count after adding cyclosporine, and the systemic corticosteroid treatment was smoothly tapered down. The mean dosage of cyclosporine was 1.68 ± 0.73 mg/kg/d, and the mean duration of cyclosporine treatment was 76.13 ± 35.64 days. Their serum eosinophil counts, serum alanine aminotransferase levels, and serum thymus and activation-regulated chemokine levels were all elevated at baseline and then significantly decreased during the recovery stage after cyclosporine therapy (P < .05). No adverse events were reported after adding cyclosporine. ConclusionCyclosporine is an effective and safe therapeutic alternative as a steroid-sparing agent for corticosteroid-dependent DRESS. Further prospective randomized controlled studies are required to confirm these preliminary results.

The role of eosinophils in sepsis and acute respiratory distress syndrome: a scoping review.

PurposeSeptic shock and acute respiratory distress syndrome (ARDS) are characterized by a dysregulated immune host response that may respond to steroid therapy. Eosinophils contribute to type 2 inflammation that often responds to steroid therapy; their role in immune dysregulation and outcomes in sepsis and ARDS is unclear.SourceA systematic search of Cochrane Library, MEDLINE, and EMBASE was performed from inception to 9 September 2020. The search comprised the following terms: eosinophils, sepsis, septic shock, and ARDS. Two reviewers independently screened abstracts and texts and extracted data on disease severity and clinical outcomes.Principal findingsThirty-nine studies were identified: 30 evaluated serum eosinophil count in sepsis, one evaluated eosinophil activity in sepsis, three assessed bronchoalveolar lavage (BAL) eosinophil count in ARDS, four assessed eosinophil activity in ARDS, and one assessed peripheral eosinophil count in ARDS. Eleven studies showed an association between eosinopenia and sepsis, and eight studies found persistent eosinopenia at > 48 hr of intensive care unit admission to predict mortality and readmission in septic patients. Three studies found BAL eosinophil count to be low in ARDS, although one found that levels rose in late-phase ARDS. Three studies found eosinophil activity markers in BAL to be high in ARDS and correlate with ARDS severity.ConclusionPersistent peripheral eosinopenia is a marker of bacterial sepsis and is independently associated with poor outcomes. Bronchoalveolar lavage eosinophil counts are low in early-phase ARDS, but increase in late-phase ARDS, while elevated markers of eosinophil activity correlate with ARDS severity. Further studies understanding the mechanisms leading to eosinopenia in sepsis and increased eosinophil activity in ARDS are needed.Supplementary InformationThe online version of this article (10.1007/s12630-021-01920-8) contains supplementary material, which is available to authorized users.

Association of serum chemokine ligand 21 levels with asthma control in adults

OBJECTIVES:The chemokine ligand (CCL) 21 regulates the maturation, migration, and function of dendritic cells, and has been implicated in the pathogenesis of asthma. This study aimed to investigate the association between serum CCL21 levels and asthma control.METHODS:The serum levels of CCL21 and other inflammatory cytokines were analyzed in patients with asthma (n=44) and healthy controls (n=35) by enzyme-linked immunosorbent assay. IgE levels and eosinophil counts were determined by turbidimetric inhibition immunoassay and fully automatic blood analysis, respectively. The Asthma Control Test (ACT) questionnaire was used, and spirometry and fractional exhaled nitric oxide (FENO) measurements were performed. A multiple unpaired Student’s t-test was performed to analyze the differences in CCL21 and interleukin levels between patients with asthma and healthy controls. The correlation of CCL21 levels with disease severity was evaluated using the Pearson’s rank correlation test.RESULTS:Serum CCL21 levels were lower in patients with asthma (254.78±95.66 pg/mL) than in healthy controls (382.95±87.77 pg/mL) (p<0.001). Patients with asthma had significantly higher levels of IL-1β (19.74±16.77 vs. 2.63±5.22 pg/mL), IL-6 (7.55±8.65 vs. 2.37±2.47 pg/mL), and tumor necrosis factor-α (12.70±12.03 vs. 4.82±3.97 pg/mL) compared with the controls. CCL21 levels were positively correlated with the ACT score (rs=0.1653, p=0.0062), forced expiratory volume in 1s (FEV1)/forced vital capacity (rs=0.3607, p<0.0001), and FEV1 (rs=0.2753, p=0.0003), and negatively correlated with FENO (rs=0.1060, p=0.0310). CCL21 levels were negatively correlated with serum IgE levels (rs=0.1114, p=0.0268) and eosinophil counts (rs=0.3476, p<0.0001).CONCLUSIONS:Serum CCL21 levels may be a new biomarker for assessing asthma control.

Çocukluk Çağı Bruselloz Özellikleri ve Hastaneye Yatışta Laboratuvar Belirteçlerinin Tanısal Rolü

Amaç: İnsan brusellozu, birçok hastalığı taklit eden sistemik bir hastalıktır ve çocuklarda da teşhis edilmesi çok zor olabilmektedir. Çocukluk çağı brusellozu, ciddi klinik tablolarla karşımıza gelebilir ve komplikasyonlara neden olabilir. Bu çalışmada, çocukluk çağı bruselloz hastalarının özellikleri ile hastaneye yatışta laboratuvar belirteçlerin tanısal rolünün araştırılması amaçlandı. Gereç ve Yöntemler: Geriye dönük olarak 1 Ocak 2018 ile 31 Aralık 2019 tarihleri arasında bruselloz tanısı alan 0-18 yaş 60 çocuk hasta değerlendirildi. Ayaktan ve hastaneye yatış verilerek izlenen bruselloz hastalarının demografik özellikleri ve klinikleri ile mikrobiyolojik ve diğer laboratuvar bulguları incelendi. Bulgular: Hastaların yaş ortalaması, 9.3±4.3 yıldı ve %41,7’si kız, %58,3’ü erkek idi. Hastaların %83,3’ünde eklem tutulumu mevcuttu. Hastaların %33,3’ü yatırılarak izlendi. Kan serum eozinofil sayıları yatan hastalarda ortanca değeri 60/µL (10-90/µL) iken ayaktan hastalarda 110/µL (55-205/ µL) değerleri arasında idi (p=0,022). Kan eozinofil sayısı kesme seviyesi ≤90/µL için; (CI %95, 54,4-93,9) duyarlılık %78,95 (Cl %95, 54,4-93,9) ve özgüllük %60,00, (Cl %95,43,3-75,1) olarak bulundu. Sonuç: Çocukluk çağı brusellozu ülkemiz için önemli bir halk sağlığı sorunu olmaya devam etmektedir. Kan eozinofil düzeyleri, çocukluk çağı brusellozunda hastalık derecesini göstermede ve yatışa karar vermede bir role sahip olabilir ama bu ilişkinin daha iyi anlaşılması, özgüllük ve duyarlılığının değerlendirmesi için daha fazla sayıda hasta ile yeni çalışmalara ihtiyaç vardır.

Endotype of Eosinophilic Nasal Polyposis According to the Presence of Atopy

Background and Objectives We evaluated differences in the pathophysiology of atopic and non-atopic eosinophilic nasal polyps and investigated their distinct inflammatory profiles.Subjects and Method A total of 36 patients were recruited: 10 controls (Group C), 14 with chronic rhinosinusitis with eosinophilic nasal polyps with atopy (Group A), and 12 without atopy (Group NA).Results Serum eosinophil counts, total immunoglobulin E, eosinophil cationic protein levels, and tissue eosinophil counts were elevated in Groups A and NA vs. Group C. Real-time polymerase chain reaction results showed increased GATA-3, interleukin (IL)-4, IL-33 levels, but decreased levels of retinoic acid-related orphan receptor gamma t, IL-17 in Groups A and NA. Related to the regulatory T (T-reg) cell response, forkhead box P3 (Foxp3&lt;sup&gt;+&lt;/sup&gt;) (A: &lt;i&gt;p&lt;/i&gt;&lt;0.001, NA: &lt;i&gt;p&lt;/i&gt;&lt;0.001) and IL-10 (A: &lt;i&gt;p&lt;/i&gt;&lt;0.001, NA: &lt;i&gt;p&lt;/i&gt;&lt;0.001) levels were elevated and transforming growth factor-β levels (A: &lt;i&gt;p&lt;/i&gt;&lt;0.001, NA: &lt;i&gt;p&lt;/i&gt;&lt;0.001) were decreased in Group A and Group NA in comparison to those in Group C. The Foxp3&lt;sup&gt;+&lt;/sup&gt; (&lt;i&gt;p&lt;/i&gt;=0.001) and IL-10 (&lt;i&gt;p&lt;/i&gt;&lt;0.001) were significantly higher in Group A than in Group NA.Conclusion T-reg cells and IL-10 may be major factors differentiating the pathophysiology of atopic and non-atopic eosinophilic nasal polyps, and the T helper (Th) 2/Th17/T-reg imbalance might be important in the development of eosinophilic nasal polyposis.

Mycosis Fungoides and Its Relationship to Atopy, Serum Total IgE, and Eosinophil Counts

IntroductionA recent serologic study and reports of increased serum total IgE (IgE-t) and eosinophil counts have suggested that the prevalence of atopy is more common in patients with mycosis fungoides (MF) than previously recognized. Patients and MethodsPatients with clinicopathologic features that were diagnostic and/or consistent with MF and/or the presence or absence of an atopic disorder (eg, allergic rhinitis, asthma, eczematous dermatitis), which was determined by patient history, eosinophil counts, and serum IgE-t obtained at evaluation, were selected from a patient registry. The MF population was divided into those with atypical and typical clinical presentations. We performed matching of controls using age, sex, and race from the 2005 to 2006 National Health Education Survey. ResultsA history of allergic rhinitis was recorded for 186 of 728 patients (25.5%) with typical MF and 71 of 229 patients (31%) with atypical MF. However, the prevalence of asthma and eczema was low. The IgE-t and eosinophil counts were higher for patients with typical MF than for controls and for patients with atopic diathesis than for patients without atopy. The IgE-t and eosinophil counts were higher for the patients with advanced-stage MF compared with those for the patients with less-advanced disease for both atopic and nonatopic cohorts. In the Cox model with age and clinical stage as covariates, a history of atopy, increased IgE-t, and blood eosinophilia (> 500 cells/mm3) did not correlate with overall survival. ConclusionThe findings from the present study did not reveal a significant association of atopy in patients with MF. However, atopy is a factor in the increased IgE-t and eosinophil counts observed in MF. Another factor is related to the disease stage, including possibly the influence of cytokines secreted by T-helper type 2-polarized neoplastic cells.

Serum IgE in the clinical features and disease outcomes of IgG4-related disease: a large retrospective cohort study

ObjectiveThe aim of this study was to investigate the role of serum IgE levels in the clinical features and outcomes of IgG4-related disease (IgG4-RD).MethodsWe retrospectively enrolled 459 newly diagnosed IgG4-RD patients with serum IgE examined at baseline from 2012 to 2019 and compared the clinical features between group A (serum IgE level ≤ 60 KU/L) and group B (serum IgE level > 60 KU/L). Subsequently, 312 patients who had been followed up for ≥ 1 year were further selected to evaluate the correlation between serum IgE level and disease outcome.ResultsAt baseline, the serum IgE level was positively correlated with the serum IgG4 level (r = 0.1779, P = 0.0001), eosinophil count (r = 0.3004, P < 0.0001), and serum IgG level (r = 0.2189, P < 0.0001) in IgG4-RD patients. Compared with group A, group B had more patients with allergic diseases (P = 0.004), more organ involvement (P = 0.003), and higher IgG4-RD responder index scores (P = 0.002). During follow-up, group A patients had a higher remission induction rate than group B patients (88.4% vs. 73.6%, P = 0.035), while group B patients had a higher relapse rate than group A patients (29.0% vs. 16.2%, P = 0.039). Multivariate analysis found that a serum IgE level > 125 KU/L at baseline was a risk factor for disease relapse (hazard ratio [HR], 1.894 [95% confidence interval (CI) 1.022–3.508]; P = 0.042). Cox regression analysis showed that elevation of the eosinophil count was a risk factor for relapse in both group A and group B patients (HR, 8.504 [95% CI 1.071–42.511]; P = 0.009; and HR, 2.078 [95% CI 1.277–3.380]; P = 0.003, respectively), and the involvement of the lacrimal gland (HR, 1.756 [95% CI 1.108–2.782]; P = 0.017), submandibular gland (HR, 1.654 [95% CI 1.037–2.639]; P = 0.035), and kidney (HR, 3.413 [95% CI 1.076–10.831]; P = 0.037) were also risk factors for relapse in group B patients.ConclusionIgG4-RD patients with high serum IgE levels at baseline were more likely to have higher disease activity, and baseline high IgE levels were associated with disease relapse.

Eosinophils, a Jack of All Trades in Immunity: Therapeutic Approaches for Correcting Their Functional Disorders.

Eosinophils are primitive myeloid cells derived from bonemarrow precursors and require the intervention of interleukin (IL)-5 for their survival and persistence in blood and tissues. Under steady-state conditions, they contribute to immune regulation and homeostasis. Under pathological circumstances, eosinophils are involved in host protection against parasites and participate in allergy and inflammation. Mostly, in asthma, eosinophils provoke airway damage via the release of granule contents and IL-13 with mucus hypersecretion and differentiation of goblet cells. Then, tissue remodeling follows with the secretion of transforming growth factor-β. Eosinophils are able to kill helminth larvae acting as antigen-presenting cells with the involvement of T helper (h)-2 cells and subsequent antibody response. However, they also exert pro-worm activity with the production of suppressive cytokine (IL- 10 and IL-4) and inhibition of nitric oxide. Eosinophils may play a pathogenic role in the course of chronic and autoimmune disease, e.g., inflammatory bowel disease and eosinophilic gastroenteritis, regulating Th2 responses and promoting a profibrotic effect. In atopic dermatitis, eosinophils are commonly detected and may be associated with disease severity. In cutaneous spontaneous urticaria, eosinophils participate in the formation of wheals, tissue remodeling and modifications of vascular permeability. With regard to tumor growth, it seems that IgE can exert anti-neoplastic surveillance via mast cell and eosinophil-mediated cytotoxicity, the so-called allergo-oncology. From a therapeutic point of view, monoclonal antibodies directed against IL-5 or the IL-5 receptors have been shown to be very effective in patients with severe asthma. Finally, as an alternative treatment, polyphenols for their anti-inflammatory and anti-allergic activities seem to be effective in reducing serum IgE and eosinophil count in bronchoalveolar lavage in murine asthma. Eosinophils are cells endowed with multiple functions and their modulation with monoclonal antibodies and nutraceuticals may be effective in the treatment of chronic disease.

STEROID DEPENDENT CHRONIC EOSINOPHILIC PNEUMONIA: A WIN FOR IL-5 ANTAGNONISM IN AN ACTIVE DUTY SERVICE MEMBER

SESSION TITLE: Fellows Diffuse Lung Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Chronic eosinophilic pneumonia (CEP) is characterized by a clinical syndrome which includes pulmonary symptoms, eosinophilia greater than 25% in bronchoalveolar lavage, and characteristic radiographic abnormalities. Corticosteroids are the mainstay of therapy. There is no standard alternative for steroid-refractory/dependent CEP, however, reports suggest anti-IL5 therapies may be an option. We present the case of a non-asthmatic, active duty service member with steroid dependent CEP who had a dramatic clinical response to mepolizumab. CASE PRESENTATION: A 47-year-old African American female presented to us for persistent productive cough and dyspnea despite multiple rounds of steroids and antibiotics for “recurrent upper respiratory infections”. Our evaluation was notable for thoracic lymphadenopathy and diffuse ground glass opacities on CT, a positive environmental allergy screen, IgE of > 4,000 IU/mL and an absolute serum eosinophil count of over 3,400. Pulmonary function testing, to include bronchoprovocation testing was normal. A diagnosis of allergic bronchopulmonary aspergillosis (ABPA) was excluded due to negative precipitins panel and lack of classic radiographic findings. Bronchoscopic evaluation revealed tissue eosinophilia with eosinophilic granuloma formation and no evidence of vasculitis. BAL from two separate lobes revealed a cell differential > 25% eosinophils with all infectious testing negative. An ANCA panel was positive for PR3, however, subsequent work up to include numerous biopsies of various sites, was not consistent with Eosinophilic Granulomatosis with Polyangitis (EGPA), especially in this non-asthmatic. We started steroid therapy for CEP which resulted in clinical improvement, however, our patient could not be weaned below 20mg daily without resulting in symptom relapse. For her steroid-dependent CEP we trialed mepolizumab, resolving her symptoms and radiographic findings, allowing cessation of all steroids DISCUSSION: IL-5 antagnosts, like mepolizumab, bind and neutralize IL-5 thereby inhibiting eosinophil production, activation and chemotaxis (1). They are used in eosinophilic asthma to relieve airway inflammation. In CEP, eosinophils also drive chronic inflammation. Steroids are classically considered the cornerstone of therapy for these patients and can generally be weaned, however, in this case the patient had steroid dependent disease necessitating consideration for alternative therapies. In the literature, anti-IL-5 therapy is non-asthmatics is discussed, however, to the best of our knowledge, there is only one published case documenting successful use of mepolizumab in CEP (2). CONCLUSIONS: Mepolizumab appears to be a promising therapy for patients with CEP and may be considered in patients who do not respond to, or are dependent on, steroids. More research must be done into such non-steroidal agents to reduce exposure to steroids and their side effects. Reference #1: 1. Garrett JK, Jameson SC, Thomson B, et al. Anti-interleukin-5 (mepolizumab) therapy for hypereosinophilic syndromes. J Allergy Clin Immunol. 2004;113(1):115-9. Reference #2: 2 To M, Kono Y, Yamawaki S, et al. A case of chronic eosinophilic pneumonia successfully treated with mepolizumab. J Allergy Clin Immunol Pract. 2018;6(5):1746-1748.e1. DISCLOSURES: No relevant relationships by Cyrus Askin, source=Web Response No relevant relationships by Tyson Sjulin, source=Web Response

IMPACT OF SERUM EOSINOPHIL COUNTS ON HOSPITAL LENGTH OF STAY, READMISSION RATES, AND IN-HOSPITAL OUTCOMES IN PATIENTS WITH ACUTE EXACERBATION OF COPD

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To assess whether serum eosinophilia increases hospital lengths of stay, readmission rates, intubation rates, and intensive care unit (ICU) admission. METHODS: This was an observational retrospective study design. We analyzed data of patients admitted for acute exacerbation of COPD (AE-COPD) between January 2011 and December 2018. Patients were stratified into high eosinophil group if the blood eosinophil count at admission was ≥2% of the total white blood cells or ≥150cells/µL. Inclusion criteria included spirometry showing FEV1/FVC ratios less than 70%, age over 40 years, and smoking history. The study was approved by the University of Missouri Institutional Review Board. RESULTS: A total of 87 patients were included in the analysis. The average age was 62 years (SD 8.95) and 57% of patients were female. The average length of stay was 4 days (SD 3.94 days). There were 16 (18%) patients with eosinophils greater than 2% and 25 (29%) patients with eosinophils greater than 150 cells/µL. The average FEV1 was 1.42L (SD 0.55L). There were 15 patients (17%) who were readmitted within 1 year. There was no difference in readmission rates between the low eosinophil group compared to the high eosinophil group (OR, 0.582; 95% CI, 0.118–2.86; P =0.725). There was also no statistically significant difference in lengths of stay between the two groups (4.23 days vs 2.56, p =0.128). There was no difference in the intubation rates (OR 0.88; 95% CI 0.096-8.09; p=.91) or ICU admission rates (OR 0.85; 95% CI 0.245-2.95 p=.798). Serum eosinophil counts decreased from admission to discharge. Inhaled corticosteroid (ICS) use prior to admission did not influence eosinophil levels. CONCLUSIONS: Peripheral eosinophilia (>2% of total white cell count) at time of admission in patients presenting with AE-COPD does not appear to have a significant impact on ICU admission, intubation, hospital LOS, or readmission. Our data is limited by a small sample size. CLINICAL IMPLICATIONS: More clinical research is required to determine the accuracy and usefulness of eosinophils as a biomarker for outcomes in patients with acute exacerbations of COPD. There is continued need to search for other biomarkers to help us better define the risk of COPD exacerbation. This is especially important in determining patients who may be at higher risk for intubation and ICU admission. DISCLOSURES: No relevant relationships by Trent Bailey, source=Web Response No relevant relationships by karthik Gangu, source=Web Response No relevant relationships by Armin Krvavac, source=Web Response No relevant relationships by Tinashe Maduke, source=Web Response No relevant relationships by Pooja Nair, source=Web Response No relevant relationships by Sara Tepe, source=Web Response

Oral Administration of Live and Dead Cells of Lactobacillus sakei proBio65 Alleviated Atopic Dermatitis in Children and Adolescents: a Randomized, Double-Blind, and Placebo-Controlled Study.

Several studies suggest that probiotics might be useful in the management of atopic dermatitis (AD). However, the efficacy and comparison between both the administration of viable and non-viable probiotics on alleviation of AD is not well studied. Therefore, the purpose of this study was to evaluate the effect of L. sakei proBio65 live and dead cells when administered (1 × 1010 cells/day) for 12weeks to children and adolescents (aged 3 to 18) with atopic dermatitis. In this randomized double-blind, placebo-controlled study, ninety patients were recruited and randomly allocated to either the L. sakei proBio65 live cells, L. sakei proBio65 dead cells, or placebo groups. Assessment of efficacy was based on the change in SCORing Atopic Dermatitis (SCORAD) score, Investigators Global Assessment (IGA) score, serum inflammatory markers such as the serum eosinophil (count), IgE, eosinophil cationic protein (ECP), CCL17 (thymus and activation-regulated chemokine [TARC]), and CCL27 (cutaneous T cell-attracting chemokine [CTACK]), and changes in skin condition (moisture and sebum) at baseline, week 6 and week 12. The SCORAD total score decreased in the live cells (p =0.0015) and dead cell group (p =0.0017) from the baseline after 12weeks, whereas there were no significant changes in the placebo group when compared with baseline. The skin sebum content increased in both the live cell (p <0.0001) and the dead cell group (p <0.0001), suggesting potential improvements in skin barrier functions. Current data suggested a positive improvement in alleviation of AD symptoms upon oral administration of L. sakei proBio65 in both viable and non-viable forms.

Association between Two Single Nucleotide Polymorphisms of Thymic Stromal Lymphopoietin (TSLP) Gene and Asthma in Iranian Population.

Thymic stromal lymphopoietin (TSLP) is a cytokine similar to IL-7, which is released by airway epithelial cells in response to injury and inflammation. Current literature is contradictory about the association between different single nucleotide polymorphisms (SNPs) of the TSLP gene and asthma development in different countries. We aimed to evaluate the association between two common TSLP SNPs (rs2289276 and rs2289278) and the risk of asthma in the Iranian population. Genotyping of the TSLP gene was performed in 126 adult asthmatic patients and 300 controls; using the TaqMan genotyping assay. Moreover, total serum IgE level and eosinophil count were assessed. The results indicated that the TT genotype of rs2289276 was inversely associated with the risk of asthma (p=0.002). A similar inverse association was detected in subgroups of atopic (p=0.001) and non-atopic (p=0.005) asthma. Moreover, the TT genotype of this SNP was more prevalent in severe and late-onset categories of asthma. In subgroup analysis, a significant sex-specific association between rs2290276 and asthma was observed in women (p=0.004). The prevalence of rs2289276 was extremely low, which made it infeasible to perform any further analysis. Overall, our findings indicated that rs2290276 SNP of the TSLP gene has a protective phenotype against asthma development in the Iranian population.