Eosinophilia

The common causes of eosinophilia are allergy (asthma, eczema, seasonal allergies) and medication (sometimes self-administered).

A more extensive list of causes is found here:

Consider intestinal / other parasites if travel history, even long ago, suggests this as a possibility.

Sustainedly raised eosinophils are toxic especially at levels above 1.5x 10⁹/l.

If there are associated new onset cardiac or pulmonary problems seek early advice.

History:

Allergic disorders

Skin rashes

Medication including accurate start dates, and time correlation with blood counts

Travel history

Thrombotic history

Cardiorespiratory

Gastrointestinal

Constitutional

Red flag malignancy symptoms ( night sweats, unintentional weightloss, pruritus)

Examination:

Signs of allergy

Skin rash

Cardiac and respiratory systems

Blood tests:

FBC and blood film

U+E, LFT, bone, LDH, CRP, vitamin B12 assay

According to above findings consider:

Stool sample requesting Ova, Cysts and Parasites

CXR, Pulmonary Function Test and possible CT thorax

Troponin T and possible Echocardiography

When to refer:

Eosinophil count is sustained above 1.5x 10⁹/l

Systemic symptoms

Evidence of end organ damage

Then

Refer to Haematology if no detectable secondary cause

Refer to secondary care, specialty according to clinical impression and site of pathology

References

BJH, Guideline for the investigation and management of eosinophilia: http://onlinelibrary.wiley.com/doi/10.1111/bjh.14488/full

Contributors:

Dr Richard Noble, Consultant Haematologist, RCHT

Dr Bridgitte Wesson, GP & Kernow RMS Haematology guideline lead

Review date: 13/07/2020

Next Review 13/07/2021