From the Guidelines
Hyper eosinophilia should be managed based on the underlying cause, with consideration of helminth infections, and treatment with antihelminthic agents such as albendazole, or corticosteroids like prednisone for symptomatic cases, as recommended by the most recent guidelines 1.
Key Considerations
- The diagnosis of hyper eosinophilia involves identifying the underlying cause, which can include helminth infections, allergic disorders, or immunodeficiency syndromes 1.
- Treatment depends on the severity of symptoms and the underlying cause, with options ranging from observation for mild cases to corticosteroids or antihelminthic agents for more severe cases 1.
- Regular monitoring with complete blood counts and organ function tests is essential to assess treatment response and detect potential complications 1.
Management Options
- For asymptomatic cases with suspected helminth infections, empirical treatment with an antihelminthic agent such as albendazole may be considered 1.
- For symptomatic or organ-threatening cases, corticosteroids like prednisone are typically first-line therapy, with gradual tapering based on response 1.
- Targeted therapies like mepolizumab or imatinib may be used in specific cases, such as hypereosinophilic syndrome with the FIP1L1-PDGFRA gene fusion 1.
Important Considerations
- Hyper eosinophilia can damage multiple organs, including the heart, lungs, skin, and nervous system, making prompt diagnosis and treatment essential to prevent irreversible organ damage 1.
- A thorough diagnostic workup, including concentrated stool microscopy and strongyloides serology, should be performed to identify the underlying cause of hyper eosinophilia 1.
From the Research
Definition and Diagnosis of Hyper Eosinophilia
- Hyper eosinophilia is defined as a peripheral blood eosinophil count greater than 1.5 × 10^9 /L, and may be associated with tissue damage 2.
- The diagnosis of hyper eosinophilia relies on a combination of various tests, including morphologic review of the blood and marrow, standard cytogenetics, fluorescence in situ-hybridization, flow immunophenotyping, and T-cell clonality assessment 2.
Classification and Subtypes of Hyper Eosinophilia
- The 2016 World Health Organization endorses a semi-molecular classification scheme of disease subtypes, including "myeloid/lymphoid neoplasms with eosinophilia and rearrangement of PDGFRA, PDGFRB, or FGFR1 or with PCM1-JAK2", and the MPN subtype, "chronic eosinophilic leukemia, not otherwise specified" (CEL, NOS) 2.
- Lymphocyte-variant hypereosinophilia is an aberrant T-cell clone-driven reactive eosinophila, and idiopathic hypereosinophilic syndrome (HES) is a diagnosis of exclusion 2.
Treatment and Management of Hyper Eosinophilia
- The goal of therapy is to mitigate eosinophil-mediated organ damage 2.
- For patients with milder forms of eosinophilia without symptoms or signs of organ involvement, a watch and wait approach with close-follow-up may be undertaken 2.
- Corticosteroids are first-line therapy for patients with lymphocyte-variant hypereosinophilia and HES 2, 3.
- Hydroxyurea and interferon-alfa have demonstrated efficacy as initial treatment and in steroid-refractory cases of HES 2, 3.
- Biologic agents, such as antibodies against interleukin-5 (IL-5) and the IL-5 receptor, are being investigated as potential treatments for hyper eosinophilia 4.