Short answer questions (SAQs)
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon in Radiology for Undergraduate Finals and Foundation Years, 2018
Eosinophilic lung disease is the presence of pulmonary infiltrates with an associated blood/tissue eosinophilia. Eosinophilia is defined as a peripheral eosinophil count > 0.44 × 109/l. Causes of eosinophilia and pneumonia include: Asthma.Loeffler’s syndrome (acute eosinophilic pneumonia).Drugs: nitrofurantoin, sulfonamides, penicillin.Parasitic infections : ascariasis, schistosomiasis.Fungal infections: allergic broncho-pulmonany aspergillois.Vasculitis-related: Wegener’s granulomatosis, Churg-Strauss, RhA, scleroderma, PAN, Sjögren’s syndrome.
Molecular Mechanisms Controlling Immunoglobulin E Responses
Thomas F. Kresina in Immune Modulating Agents, 2020
Whereas IL-4 is critical to IgE production, another type 2 cytokine, IL-5, acts as a differentiation and growth factor for eosinophils during allergic disease. Interleukin-5, IL-3, and GM-CSF all induce eosinophil production, as demonstrated in both in vitro and in vivo experiments [44], but only IL-5 is specific for the eosinophil lineage. The IL-5 stimulates eosinophilopoiesis in the bone marrow [45] and promotes the terminal differentiation of myeloid precursors into eosinophils [46]. Eosinophils play an essential role during allergic diseases and parasitic infections by releasing eosinophil-derived proteins such as major basic protein (MBP) and the eosinophilic cationic protein (ECP). In helminthic and parasitic infections, the eosinophilie-derived granules are believed to be toxic to the infesting cells. In asthma, epithelial shedding is believed to result from the release of eosinophil major basic protein [47], and mucus hypersecretion and airway hypereactivity are believed to be consequences of the release of the eosinophil and mast cell-derived leukotriene C4, which is cleaved to the active products leukotriene D4 and E4 [48]. In addition, IL-5 promotes the migration of eosinophils from the blood to the tissues in response to antigen challenge [49,50] and increases eosinophil, but not neutrophil, adhesion to vascular endothelium [51]. Although IL-5 does not contribute to IgE production, the Th2 immune response that promotes IL4, IL-13, and IL-5 secretion, all contribute to the inflammation-related symptoms in complementary ways.
Allergy–Asthma Practice
Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial in Textbook of Allergy for the Clinician, 2021
Asthma is a disorder affecting almost 7% of the population. Many patients with asthma have a mild disease which is managed by a primary care physician who does not have specific training in allergy/asthma. However patients with more complex allergies and asthma are seen by allergists. Currently the evaluation generally includes lung function testing, exhaled nitrous oxide and allergy testing. Since the addition in 2001 of ICS/LABA’s the management of asthma has been significantly improved. There are currently a number of preparations containing a combination of ICS/LABA for both children and adults. A small percentage of patients are uncontrolled despite these new and better medications. It is now recognized that a certain phenotype often referred to as eosinophilic asthma in which there are high levels of peripheral eosinophils. These patients are benefited by the addition of new biologic medications that interfere with cytokine production particularly anti-IL-4, anti-IL-5 and anti-IL-13. Currently there are four biologics therapies available for allergists to use in the treatment of severe eosinophilic asthma. These agents are expensive and are only used when all other options are not controlling the patient’s asthma. Some biologics are now approved for children 6 years of age and older.
Blood eosinophils in COPD: friend or foe?
Published in Expert Review of Respiratory Medicine, 2022
Anastasia Papaporfyriou, Petros Bakakos, Georgios Hillas, Andriana I. Papaioannou, Stelios Loukides
Eosinophils are cells with diverse functions, which play roles in homeostasis and disease [14]. Their main role is to respond effectively to noxious insults without causing an inappropriate and damaging inflammatory response [8]. Eosinophilic inflammation contributes to host defense and allergic diseases and has an important role against helminth infection [15]. Furthermore, eosinophil activation has been also observed during infections caused by Haemophilus influenzae and in cases of viral infections caused by human respiratory syncytial virus (RSV) and rhinovirus [16–18]. However, it seems that eosinophil responses vary depending on the applied stimulus, the cellular environment, and the tissue they reside. Enhanced tissue survival of eosinophils is mediated by the action of interleukin 5 and granulocyte macrophage colony-stimulating factor (GM-CSF) [19].
Effective treatment with omalizumab of a patient with spontaneous chronic urticaria and eosinophilic esophagitis
Published in Journal of Dermatological Treatment, 2018
Eugenio Provenzano, Pietro Morrone
Omalizumab is a humanized monoclonal antibody directed against E immunoglobulin (IgE), recommended for the treatment of allergic asthma and of chronic spontaneous urticaria (CSU) resistant to treatment with antihistamines (1). Urticaria is a series of skin conditions characterized by itching wheals, possibly associated with angioedema. Urticaria recurring for longer than 6 weeks is defined chronic, while acute urticaria usually lasts less than 3 weeks (2). Chronic urticaria heavily affects the quality of life of the patient and it is not easily managed. Eosinophilic esophagitis is a chronic inflammatory disease, characterized clinically by dysphagia and pathologically by eosinophilia of the esophagus. Diagnosis is made by 3 criteria: symptoms of esophageal dysfunction; presence of ≥15 eosinophils/high power field in at least 1 esophageal biopsy, with few exceptions; eosinophilia limited to the esophagus, with exclusion of other possible causes of esophageal eosinophilia, including proton pump inhibitors (PPI) responsive esophageal eosinophilia. It may be associated with allergy and epigastric pain, and symptoms do not respond to proton pump inhibitors (PPI) (3). This article reports the history of a patient affected by antihistamines-refractory CSU and eosinophilic esophagitis, who had remission of both diseases after therapy with omalizumab.
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.