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Allergy–Asthma Practice
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Mark Holbreich, Pudupakkam K Vedanthan, PA Mahesh, Sitesh Roy
Eosinophilic esophagitis is a disease characterized most commonly by dysphagia in adults and chronic abdominal complaints in children. It was first recognized in 1986 and over the past 10 years the disease has been better defined. Although found throughout the world it is most prevalent in caucasian males living in developed countries. The treatment may consist of a diet or swallowed corticosteroids. It is a chronic and progressive disease.
Regulation of Eosinophil Mediator Release by Adhesion Molecules
Published in Bruce S. Bochner, Adhesion Molecules in Allergic Disease, 2020
At present, eosinophils are recognized as pro-inflammatory cells and likely play a major role in allergic diseases, such as bronchial asthma and atopic dermatitis. The eosinophil is an important source of cytotoxic proteins, lipid mediators, and oxygen metabolites, which have the potential to induce pathology in disease. Recent studies on cell adhesion molecules suggest that in addition to adhesive interactions, adhesion molecules modulate intracellular signaling pathways and regulate effector functions of the cells. The purpose of this chapter is to discuss the potential roles of adhesion molecules as regulators of mediator release from eosinophils.
Mucosal basophils, eosinophils, and mast cells
Published in Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald, Principles of Mucosal Immunology, 2020
Edda Fiebiger, Stephan C. Bischoff
Eosinophil granulocytes are bone marrow–derived leukocytes involved in inflammatory and immunoregulatory processes. This dual function of eosinophils is similar to that of basophils and mast cells. Obviously, inflammatory and immunoregulatory functions are frequently combined in the same cell type. Like basophils and mast cells, which are discussed later in this chapter, eosinophils exert many biological functions by releasing humoral mediators that preferentially function locally in a paracrine manner. Both the factors that regulate eosinophil development and activation and the mediators that are released on activation are discussed. Consistent with the pleiotropic functions of eosinophils in health and disease, eosinophils are capable of releasing a wide range of granule-associated proteins and cytokines, upregulating a variety of cell-surface receptors and adhesion molecules, and potentially providing antigen-presentation functions for T cells. Eosinophils participate in parasitic and helminth infections, virus infections, asthma, gastrointestinal diseases, and neoplastic disorders of the leukocyte lineage and are thus an important component of mucosal immunity.
Combination therapy with immune check point inhibitors and acute kidney injury
Published in Acta Oncologica, 2023
Amalie Valentin, Anne Kirstine Hundahl Møller, Jesper Andreas Palshof, Bo Broberg, Eva Gravesen, Inge Marie Svane, Ditte Hansen
The causes of AKI are shown in Table 1. Two patients had potential ICI-related AKI, CTCAE grade 2 and 3 respectively (graded using baseline p-creatinine). The interval from the initiation of ipilimumab and nivolumab to the occurrence of ICI-related AKI was 50 days and 84 days respectively. Both patients received treatment with high doses of methylprednisolone with significant improvement of kidney function, but some degree of chronic kidney disease remained in both (CKD stage 2 and 4 respectively). One of these patients underwent a kidney biopsy showing acute interstitial nephritis. This patient had a relapse of ICI-related AKI 11 months after receiving treatment with ipilimumab and nivolumab. This also responded with a partial remission to methylprednisolone treatment (Figure 1). None of the patients was treated with second-line immunosuppressive drugs. The other patient with potential ICI-related AKI in this group experienced a relapse with increasing p-creatinine while still treated with low-dose glucocorticoids for an ICI–related AKI. This responded to an increased dose of glucocorticoids and a prolonged treatment period. Blood samples revealed a slightly elevated eosinophil count in the patient.
Eosinophilic granulomatosis with polyangiitis
Published in Postgraduate Medicine, 2023
The diagnosis of EGPA results from the combination of a detailed medical history, complete physical exam, laboratory and imaging tests, and tissue biopsy when possible. High blood eosinophils are seen in almost all patients. These rapidly normalize after therapy with GC is initiated, and patients are often given GC for relief of rhinosinusitis and asthma symptoms, before the diagnosis of EGPA is suspected. Establishing the correct diagnosis of EGPA may depend on obtaining past laboratory tests searching for the presence of eosinophilia prior to any GC use. As mentioned before, ANCA is positive in only 30% to 40% of patients, thus a negative ANCA does not exclude the diagnosis of EGPA. When the ANCA test is positive, MPO-ANCA is usually seen (>80%) with anti-proteinase ANCA (PR3-ANCA) being unusual [4].
Systemic eosinophilic disease presenting as dacryoadenitis
Published in Orbit, 2023
Kayla Danesh, Liza M. Cohen, Yan Liu, Justin N. Karlin, Daniel B. Rootman
Eosinophilic asthma is a subtype of asthma distinguished by increased severity, association with atopy, late onset and eosinophilic cellular infiltrate in the airway.2 Patients typically respond to corticosteroids and T-helper type 2 (Th2) targeted treatments, such as anti-IL-5 therapy.2 Very little evidence is available regarding the association between this disorder and orbital inflammation, which is more typical of EGPA. However, our two patients’ presentations with obstructive airway symptoms, respiratory distress, eosinophilia and response to corticosteroids in both and anti-IL-5 therapy in one, make this a potential diagnosis. Eosinophilic infiltration of the lacrimal gland may be a manifestation of this systemic disease, similar to the eosinophilic infiltration of the respiratory system found in this condition. The lacrimal gland contains a high density of lymphatic tissue,3 and dacryoadenitis is not infrequently a sign of systemic inflammation. Lacrimal gland involvement in eosinophilic asthma could be attributable to this same mechanism.