Treatment of eosinophilic and hypereosinophilic disorders

Aparna Daley, Gisoo Ghaffari

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

This chapter introduces an approach to the management of eosinophilic and hypereosinophilic disorders. Management of eosinophilic disorders, in general, depends on the severity of peripheral eosinophilia and whether eosinophilia is secondary to other conditions or is a primary condition due to the clonal expansion of eosinophils in the bone marrow. Objectives of treatment include managing and preventing organ damage, halting the progression of the disease, improving signs and symptoms, managing complications, and lowering the burden of absolute eosinophil count. Secondary causes of peripheral eosinophilia include infections, most commonly parasitic infestations, allergic and atopic disorders and related conditions, medications, malignancies, autoimmune, endocrine disorders, and other miscellaneous conditions. In these conditions, management should be focused on the treatment of the underlying condition or disorder. Parasitic infestations being the most common cause of eosinophilia worldwide require treatment of helminthic or other parasitic infestations. Atopic disorders and allergic reactions should be treated accordingly. Reaction to medications with a wide range of symptom severity is another common cause of secondary eosinophilia, in which the culprit medication should be removed. Primary eosinophilic disorders are those in which no such underlying etiology can be identified and are categorized as hypereosinophilic syndromes (HES). Identifying the molecular basis of HES is extremely important, as there are different considerations for the treatment of lymphocytic versus myeloproliferative variant HES. While tyrosine kinase inhibitors are considered the first-line treatment for myeloproliferative HES, steroids and steroid-sparing agents including monoclonal antibodies are considered the treatment of choice for lymphocytic variant HES. Special considerations for treatment should be given such as when there are cardiac, pulmonary, neurological, and mucocutaneous manifestations.

This chapter begins with a brief review of key definitions, which are important to define specific management. It then discusses important steps in the management rationale, which include excluding secondary causes, deciding the focus of treatment, risk assessment, and a general approach to eosinophilic disorders and associated complications. Thereafter, it details the discussion of literature findings specific for individual medications utilized in the management. By the end of the chapter, the general and more specific management strategies of eosinophilic disorders are explained, in the context of findings of clinical trials in the literature. The review of clinical studies is also important for the reader, given the changing definitions and also the less well-defined guidelines in the management of such disorders. The chapter walks the reader through a rationale for the management of such disorders, including pertinent details from the literature.

Original languageEnglish (US)
Title of host publicationAllergic and Immunologic Diseases
Subtitle of host publicationA Practical Guide to the Evaluation, Diagnosis and Management of Allergic and Immunologic Diseases
PublisherElsevier
Pages1281-1308
Number of pages28
ISBN (Electronic)9780323950619
ISBN (Print)9780323953238
DOIs
StatePublished - Jan 1 2022

All Science Journal Classification (ASJC) codes

  • General Medicine
  • General Immunology and Microbiology

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