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PubMed1995

Blood eosinophil counts and arterial oxygen tension in acute asthma.

OBJECTIVE: To investigate whether during acute asthma episodes a decrease in blood eosinophil count could correlate with the severity of the disease. DESIGN: Prospective study on paediatric asthmatic patients admitted for acute asthma exacerbation between January 1992 and August 1993. All patients were regularly followed up in an outpatient clinic and had had a complete clinical evaluation < 1 month before admission. SETTING: Pulmonary division of the G Gaslini paediatric research institute, Genoa, Italy. SUBJECTS: 21 asthmatic patients, 59 (SEM 9) months of age, admitted for acute asthma exacerbation. On the basis of clinical evaluation and the results of blood and microbiological tests performed during acute asthma exacerbations, patients were divided into two subgroups: infected (n = 13) and non-infected (n = 8). RESULTS: All but one of the patients showed a marked decrease in blood eosinophil count during the acute asthma episode, in comparison with recent count (< 1 month before admission) obtained in clinically stable conditions: 662 (116) v 210 (54) eosinophils/mm3, p < 0.0003. The decrease in the eosinophil count was more pronounced in the infected patients than in the non-infected patients, but the difference was not statistically significant (p > 0.05). Similarly, transcutaneous arterial oxygen pressure (PaO2) values measured during acute asthma exacerbations tended to be lower in infected patients, without, however, reaching statistical significance: 8.6 (0.7) v 10.1 (0.9) kPa, p > 0.05). The correlation between the decrease in blood eosinophil count and PaO2 during the acute asthma exacerbations was significant in all the patients (r2 = 0.235, p = 0.022) and in the non-infected patients (r2 = 0.653, p = 0.015), but not in infected patients. In this latter subgroup, a significant negative correlation was found between blood neutrophil counts during acute asthma exacerbations and PaO2 (r2 = 349, p = 0.026). CONCLUSIONS: During acute asthma exacerbations in atopic patients without clinical evidence of infection, the decrease in blood eosinophil count correlates significantly with the decrease in PaO2, further supporting the role of eosinophils in allergic asthma.

Acute Disease↗
PubMed2000

[Rapidly progressive, refractory eosinophilia with a 250,000/microliter eosinophil count].

A 31-year-old man had received corticosteroids for 20 months for treatment of a brain tumor, and his blood eosinophil count ranged from 100/microliter to 1,000/microliter. On June 24th, 1998, he was re-admitted because of dyspnea secondary to left massive pleural effusion. Peripheral blood examination revealed an eosinophil count of 48,000/microliter. The eosinophils were hypersegmented, with abnormal distribution of eosinophilic granules and formation of cytoplasmic vacuoles. Blasts and basophils were not increased, hemoglobin was 13.4 g/dl, and the platelet count was 79,000/microliter. Bone marrow was slightly hypercellular with 55% eosinophils and 0.2% blasts. The patient's karyotype was normal, and Wilms' tumor gene was not detected. Serum IgE was normal and serum vitamin B12 and soluble IL-2 receptor were elevated. Serum levels of eosinophilopoietic cytokines, IL-3, IL-5, and GM-CSF, were low. Specimens of pleural fluid contained many eosinophils. Because the eosinophil count increased to 110,000/microliter on July 2nd, hydroxyurea was started without effect. On July 16th, the eosinophil count reached 167,000/microliter, and vincristine was added. The eosinophil count rose to 253,000/microliter the next day, and cytarabine and daunorubicin were administered, but the patient died of septic shock. Although the clinical course suggested eosinophilic leukemia, monoclonal proliferation of eosinophils was not demonstrated. To our knowledge, this is the highest peripheral blood eosinophil count reported in the literature to date.

Adult↗
PubMed1998

Immunoglobulin E and eosinophil counts are increased after sepsis in trauma patients.

OBJECTIVES: To determine the time course of plasma immunoglobulin E (IgE) concentration increases after traumatic injury, if increased IgE concentrations were related to clinical events or complications, and if increased peripheral eosinophil counts could be related to trauma, sepsis, or organ-specific complications. DESIGN: Data relating to severity of injury, clinical complications, plasma concentrations of IgE, and peripheral eosinophil counts were prospectively collected. SETTING: Trauma service, tertiary-care medical center. PATIENTS: One hundred adult trauma patients admitted to the intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Plasma IgE concentrations increased in most patients. However, the greatest increases were observed in patients with sepsis (p = .03), renal dysfunction (p = .04), or pneumonia (p = .02). IgE increases were not related to severity or mechanism of injury, allergy history, or age. The day of highest observed IgE concentration was related to the day of onset of sepsis (p = .012, r = .39), and occurred a mean of 3.8 days after sepsis. Most patients had increased peripheral eosinophil counts and eosinophil percentages of white blood cells during their intensive care unit stays. Eosinophil counts were greater in patients with sepsis (p < .0001), severe sepsis (p < .0001), or pneumonia (p < .002). CONCLUSIONS: Increased IgE concentrations and eosinophil counts were found after sepsis and do not appear to be related to the initial injury. Since IgE and eosinophil production are enhanced by interleukin-4 and interleukin-5, respectively, these findings suggest that T-helper lymphocyte type 2 cytokines are activated in response to sepsis after traumatic injury.

Adolescent↗
PubMed1995

Peripheral eosinophil counts as a marker of disease activity in intrinsic and extrinsic asthma.

BACKGROUND: Recently it has been suggested that the bronchospasm and hyperresponsiveness phenomena observed in asthma are secondary to the actions of the eosinophils; the purpose of this study was to evaluate the relationship between the peripheral number of eosinophils and various markers of disease activity in a group of asthmatics examined in childhood (mean age 10 years) and early adulthood (mean age 21 years). METHODS: The relationship between eosinophil count and pulmonary function (FEV1), respiratory symptoms, bronchial responsiveness to histamine and diurnal variation in peak expiratory flow rate (PEF) was studied in 70 subjects with bronchial asthma, of whom 24 had intrinsic and 46 extrinsic asthma. Self-reported symptoms of asthma were graded on a scale from 0 to 5, where 0 = no symptoms within the preceding 12 months and 5 = daily including nocturnal symptoms, and histamine responsiveness was analysed by means of the dose-response slope (DRS). RESULTS: In both childhood and adulthood, a direct correlation was found between blood eosinophil count and symptom score (r = 0.69, P < 0.001 and r = 0.58, P < 0.001, respectively), whereas inverse correlations were observed between number of eosinophils and FEV1 % predicted (r = -0.75, P < 0.001 and r = -0.80, P < 0.001, respectively). Furthermore, in adulthood, eosinophil count was found to be significantly correlated to histamine responsiveness (logDRS) (r = 0.65, P < 0.001) and diurnal PEF variation (r = 0.81, P < 0.001); these correlations were also noted after dividing the subjects into intrinsic and extrinic asthmatics. In both groups of subjects a significant inverse correlation was also found between histamine responsiveness and prechallenge FEV1 % predicted. The eosinophil count in childhood was weakly correlated to the symptom score in adulthood (r = 0.29, P < 0.02). CONCLUSIONS: This study showed a relationship between eosinophil count and severity of asthmatic symptoms, level of pulmonary function, histamine responsiveness and diurnal variation in PEF in both intrinsic and extrinsic asthma; suggesting that the peripheral eosinophil count reflects asthmatic activity, and possibly the degree of inflammation in the airways, in both children and adults. Furthermore, a low number of eosinophils in childhood might be related to a relatively favourable prognosis with regard to symptoms of asthma in early adulthood.

Adolescent↗
PubMed1996

[Eosinophil count in asthma. A marker of disease activity in intrinsic and extrinsic asthma].

The relationship between eosinophil count and pulmonary function (FEV1), respiratory symptoms, bronchial responsiveness to histamine and diurnal variation in peak expiratory flow rate (PEF) was studied in a group of asthmatics (n = 70) examined in childhood (mean age 10 yrs) and early adulthood (mean age 21 yrs), of whom 24 had intrinsic and 46 extrinsic asthma. Self-reported symptoms of asthma were graded on a scale from zero to five; histamine responsiveness was analysed by means of the dose-response slope (DRS). In both childhood and adulthood, a direct correlation was found between blood eosinophil count and symptom score (r = 0.69, p < 0.001 and r = 0.58, p < 0.001, respectively), whereas inverse correlations were observed between number of eosinophils and FEV1 expressed as percentage of predicted values (r = -0.75, p < 0.001 and r = -0.80, p < 0.001, respectively). Furthermore, in adulthood, eosinophil count was found to be significantly correlated to histamine responsiveness (logDRS) (r = 0.65, p < 0.001) and diurnal PEF variation (r = 0.81, p < 0.001); these correlations were also noted after dividing the subjects into intrinsic and extrinsic asthmatics. The findings in the present study suggest that the peripheral eosinophil count reflects asthmatic activity, and possibly the degree of inflammation in the airways, in both children and young adults.

Adolescent↗
PubMed1999

Relationship between interleukin-5 production and variations in eosinophil counts during HIV infection in West Africa: influence of Mycobacterium tuberculosis infection.

Eosinophils are important effectors of the non-specific immune response and we studied whether perturbations in the production of the type 2 cytokine, interleukin-5 (IL-5), could account for the variations in eosinophil counts observed in human immunodeficiency virus (HIV) infection. HIV-infected patients without helminthiasis were investigated in a cross-sectional study in West Africa. Eosinophil counts were significantly higher in CDC-B patients than in controls, but were dramatically decreased at the CDC-C stage. Phorbol 12-myristate 13-acetate (PMA)+ ionomycin-induced IL-5 production by peripheral blood mononuclear cells (PBMC) was decreased from the A stage of the disease, and significant correlations were observed between IL-5 production and eosinophil counts in tuberculosis (TB)-negative HIV-1-positive, TB-positive HIV-1-positive and TB-positive HIV-negative patient groups. Nevertheless, the production of IL-5 was not decreased in HIV-positive patients with TB, in contrast to HIV-positive patients without TB presenting with the same ranges of CD4+ counts. Our data suggest that, during HIV infection, the impairment in IL-5 production is one of the factors associated with the 'paradoxal' eosinopenia observed in tropical areas, but that IL-5 production during active TB is compensated by cellular subsets, yet to be identified.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Eosinophil count in induced sputum samples as a marker of airway inflammation and adequacy of corticosteroid inhalation treatment in asthmatic patients].

We tried to use eosinophil counts in induced sputum samples as a marker of airway inflammation, and as a guide for reducing inhaled corticosteroids in patients with well-controlled persistent asthma. The eosinophil count in induced sputum smears was defined as follows: Eos%; eosinophil percentage of 200-400 leukocytes in properly cell-separated fields, TEC; total eosinophil counts in the 5 most eosinophil-dense high power view fields (x 400). First, the eosinophil count in induced sputum samples was compared between 29 asthmatic subjects treated with inhaled corticosteroid and 15 age- and sex-matched healthy controls. Second, inhaled corticosteroid was reduced by 50% in 20 patients with green-zone asthma (morning PEF > 80% of patient's best PEF). PEF measurements were followed prospectively for 12 weeks thereafter. Once PEF decreased below 70% of their best PEF, subjects were considered as treatment "failures". Both Eos% and TEC were significantly higher than in the controls, even in well-controlled (morning PEF > 80% of their best) asthmatic patients (p = 0.001, 0.03). The chance of treatment "failure" was significantly higher in those having more eosinophils (Eos% > 10%, TEC > 100) in their initial induced sputum sample (p = 0.03, 0.001). Airway inflammation still persists in many well-controlled chronic asthmatic patients, and induced sputum eosinophilia predicts an early decrease of PEF after reduction of inhaled corticosteroids.

Administration, Inhalation↗
PubMed1975

Total eosinophil counts in the management of bronchial asthma.

Total eosinophil counts were investigated in asthmatic patients to determine their usefulness in the diagnosis and management of steroid-dependent asthma. Counts averaged 122 plus or minus 74 (S.D.) per mm-3 (65 untreated normal subjects) and 43 plus or minus 22 per mm-3 (six prednisone-treated normal subjects). Fifty-two patients with active bronchial asthma showed significant eosinophilia (greater than 350/mm-3 off and greater than 85/mm-3 on steroids), suggesting that eosinophilia is an important diagnostic feature of bronchial asthma. In 14 patients (60 observations), the counts showed significant inverse correlation with specific airway conductance--r equals 0.74, p less than 0.001--and with a variety of other measurements of bronchial dynamics and lung volumes, suggesting that the total eosinophil count reflects asthmatic activity and is useful for regulating steroid dosage and for early detection of exacerbations.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Low breast milk IgA and high blood eosinophil count in breast-fed newborns determine higher risk for developing atopic eczema after an 18-month follow-up.

Eosinophil count and IgA breast milk were evaluated at birth in 120 mother-newborn pairs with an 18-month prospective follow-up study. Our study showed a higher risk of developing atopic eczema in newborns with eosinophil count higher than 500 cell/mm3 and with IgA breast milk less than 220 mg/dl (odds ratio 17.6 CI 5.4 to 57.2 p < 0.000086). IgA breast milk is significantly less and eosinophil count is significantly higher at birth in children who develop atopic eczema. This study demonstrates the usefulness of newborn eosinophil count and mother total IgA breast milk level as combined risk factors in the development of atopic eczema in breast-fed babies.

Adult↗
PubMed2005

Effects of smoking and blood eosinophil count on the development of arteriovenous fistulae thrombosis in hemodialysis patients.

Arteriovenous fistulae (AVF) failure is the most common cause of morbidity and hospitalization in hemodialysis (HD) patients. The purpose of this study was to determine the effects of smoking and blood eosinophil count on the development of AVF thrombosis in HD patients. This cross-sectional study included 141 patients (M/F 80/61; age 43.4 +/- 11.6 years, HD duration 7.7 +/- 4.4 years). The following were analyzed as possible risk factors for AVF failure for all patients: demographic features, dialysis time, smoking, medications, body mass index, comorbid diseases, and various laboratory parameters (whole blood count and serum levels of albumin, calcium, phosphorus, uric acid, C-reactive protein, ferritin, and parathyroid hormone). AVF thrombosis was detected in 60 patients; in contrast, 81 patients had no thrombosis. Distributions of age, gender, and HD duration were similar between both groups. Univariate analysis showed that snuffbox AVF location (P < .0001), higher blood eosinophil count (P < .0001), smoking (P < .01), and higher hematocrit level (P < .05) were all associated with AVF thrombosis. According to multivariate analysis by logistic regression models, eosinophil count (RR = 1.005, P < .05) and snuffbox location (RR = 5.970, P < .05) were predictors of AVF thrombosis. When AVF location was excluded from the analysis, smoking (RR = 4.140, P < .01) and high blood eosinophil count (RR = 1.006, P < .005) were independent risk factors for thrombosis. Our study indicates that smoking and high blood eosinophil count may contribute to the development of AVF thrombosis.

Adult↗
PubMed1999

Basophil histamine release, IgE, eosinophil counts, ECP, and EPX are related to the severity of symptoms in seasonal allergic rhinitis.

BACKGROUND: Serum specific IgE, basophil histamine release, and blood eosinophil parameters are associated with allergic rhinitis, but investigations of the relationship to the severity of allergic symptoms are few and conflicting. Our study aimed to investigate the seasonal changes in the following laboratory tests: specific IgE, basophil histamine release, eosinophil counts, and serum and plasma eosinophil cationic protein (ECP) and eosinophil protein X (EPX), and to analyze, in detail, the relationship of each individual test to the severity of symptoms in rhinitis patients allergic to both birch and grass pollen. METHODS: The above tests were performed on blood samples obtained from 49 allergic rhinitis patients during the birch-pollen season, during the grass-pollen season, and after the seasons. Symptom-medication diaries were filled in during both pollen seasons. We used partial least square (PLS) analysis to establish an optimal statistical link between the symptom score and medication and the laboratory tests, in an investigator-independent way. RESULTS: Increases in specific IgE, basophil histamine release, eosinophil counts, serum ECP and EPX, and plasma EPX were observed from the birch-pollen season to the grass-pollen season, followed by a decrease from the grass-pollen season to after the pollen seasons, except for the specific IgE. No seasonal changes in plasma ECP and total IgE were seen. The PLS analysis found a relationship between symptom score and medication and the aggregate laboratory tests (F-test value 40.2, correlation 0.34 for the cumulative relation). However, the variation in laboratory tests could explain only half of the total variation in symptoms and less than a quarter of the total variation in medication. The symptom score and, to a minor degree, medication were especially correlated with the basophil histamine-release results, with a decreasing relevance of specific IgE, eosinophil counts, total IgE, serum and plasma EPX, and serum ECP. Plasma ECP was not related to the symptom score and medication. CONCLUSIONS: A significant relationship between the severity of allergic rhinitis and various allergic inflammatory markers was found but could account for only a minor part of the variation in the patients' evaluation of their disease.

Adolescent↗
PubMed1994

[Measurement of plasma histamine, urinary N-methylhistamine and peripheral eosinophil counts in food provocation tests in infants and children with atopic dermatitis].

N-methylhistamine (NMH) of the urine histamine metabolite, plasma histamine and eosinophil counts in the blood were determined in fourteen atopic children (aged 5 months-6 years, Mean = 2.8 years, M:F = 7:7) with food hypersensitivities. Urinary NMH levels during six hours in positive provocation tests were much higher than in those of negative provocation tests (534 +/- 331 micrograms/g Cr in positive tests versus 343 +/- 58 micrograms/g Cr in negative [p < 0.005]). Eosinophil counts during three hours in positive provocation tests were much lower than they were before the tests (530 +/- 239/microliters versus 248 +/- 142/microliters [p < 0.001]). However plasma histamine levels were elevated in only three of seven patients in positive food provocation tests. In addition, the percent changes in NMH levels and eosinophil counts in positive provocation tests were much higher than in those of negative provocation tests (p < 0.02, p < 0.001). Therefore it is suggested that changes in urinary NMH levels and eosinophil counts in the blood are good parameters for diagnosing food hypersensitivity in children.

Child↗
PubMed2002

Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial.

BACKGROUND: Treatment decisions in asthma are based on assessments of symptoms and simple measures of lung function, which do not relate closely to underlying eosinophilic airway inflammation. We aimed to assess whether a management strategy that minimises eosinophilic inflammation reduces asthma exacerbations compared with a standard management strategy. METHODS: We recruited 74 patients with moderate to severe asthma from hospital clinics and randomly allocated them to management either by standard British Thoracic Society asthma guidelines (BTS management group) or by normalisation of the induced sputum eosinophil count and reduction of symptoms (sputum management group). We assessed patients nine times over 12 months. The results were used to manage those in the sputum management group, but were not disclosed in the BTS group. The primary outcomes were the number of severe exacerbations and control of eosinophilic inflammation, measured by induced sputum eosinophil count. Analyses were by intention to treat. FINDINGS: The sputum eosinophil count was 63% (95% CI 24-100) lower over 12 months in the sputum management group than in the BTS management group (p=0.002). Patients in the sputum management group had significantly fewer severe asthma exacerbations than did patients in the BTS management group (35 vs 109; p=0.01) and significantly fewer patients were admitted to hospital with asthma (one vs six, p=0.047). The average daily dose of inhaled or oral corticosteroids did not differ between the two groups. INTERPRETATION: A treatment strategy directed at normalisation of the induced sputum eosinophil count reduces asthma exacerbations and admissions without the need for additional anti-inflammatory treatment.

Adult↗
PubMed1999

Do eosinophil counts correlate differently with asthma severity by symptoms versus peak flow rate?

BACKGROUND: Discrepancy in asthmatic assessment by symptoms and peak flow rate (PFR) is a frequent dilemma. Currently, total peripheral eosinophil count (TPEC) is under study for asthma evaluation. OBJECTIVES: To explore the correlation between TPEC and asthma severity assessed by symptoms alone versus symptoms and PFR. METHOD: Adults asthmatics were selected from the Asthma Clinic. Severity assessment was based on two methods: symptoms alone or symptoms and PFR. Expiratory PFR was recorded by a Wright peak flow meter. Severity levels included mild intermittent, mild persistent, moderate persistent, and severe persistent. Total peripheral eosinophil count was performed on a Celldyn-3500 counter. Data was analyzed for statistical significance. RESULTS: Sixty asthmatics aged 15 to 70 years (mean = 34 years), of which 68.3% were female, were studied. Severity levels differed between the two assessment methods in 45% of the cases and showed a predominance of the moderate persistent type. Total peripheral eosinophil count ranged between 22 and 2470 cells/mm3 (mean = 520 +/- SD = 393) and eosinophilia was found in 50% of the cases. Total peripheral eosinophil count showed a high positive correlation with increased asthma severity level assessed by history alone (r = 0.460, P < .001); more than by history and PFR (r = 0.328, P < .05). CONCLUSION: The discrepancy between symptoms and PFR is confirmed by these results. A reliable objective parameter in asthma assessment is a continuous challenge. This study advocates the possible supplementation of TPEC as another objective parameter that might help in selecting the appropriate severity level in asthmatics.

Adolescent↗
PubMed2000

Eosinophil counts and plasma fibrinogen in patients with vasospastic angina pectoris.

Epidemiologic studies have suggested a relation between white blood cell (WBC) counts and the incidence of coronary heart disease. However, the relation between vasospastic angina pectoris (VAP) and WBC counts remains to be elucidated. To clarify the relation between differential and WBC counts in VAP, we compared the hematologic values, blood chemical values, plasma fibrinogen levels, C-reactive protein levels, and coronary risk factors in patients with spontaneous attacks of VAP (n = 39) with those in patients with stable effort angina pectoris (EAP, n = 35) and in control subjects (n = 19). Patients with VAP were further divided into mild VAP (n = 22) and severe VAP groups (n = 17). There were no differences in the coronary risk factors, body temperature, total WBC counts, and C-reactive protein levels among the control, EAP, mild VAP, and severe VAP groups, except that the high-density lipoprotein cholesterol in the EAP group was significantly lower than that in the control group (p <0.01). In contrast, the eosinophil counts were significantly higher in the severe VAP group than in the other 3 groups (p <0.01). Plasma fibrinogen levels were also significantly higher in the severe VAP group than in the other 3 groups (p <0.05). The follow-up study for differential and WBC counts in patients with VAP (n = 23) demonstrated that, after medical therapy, the eosinophil counts were significantly decreased to the some level as those in the control group (p <0.0001). Thus, the eosinophil counts and plasma fibrinogen levels could predict the severity of VAP. Furthermore, a follow-up study in patients with VAP suggests that coronary vasospasm could result in an increase in eosinophil counts.

Angina Pectoris↗
PubMed1992

Blood eosinophil count as risk factor for relapse in acute asthma.

In this retrospective investigation comprising 54 adult patients included in two studies of the treatment of acute asthma, the risk of relapse was studied. The set of variables that best predicted the length of time before a new asthmatic attack comprised blood eosinophil count (P less than 0.001), FEV1 on arrival (P less than 0.001) and increased medication on discharge (P less than 0.01). The set of variables that best predicted the number of new attacks during a period of 1 yr consisted of eosinophil count (P less than 0.001), FEV1 (P less than 0.001), increased medication on discharge, age and breathing rate on arrival (P less than 0.05). Patients with an eosinophil count of more than 500 x 10(6) l-1 and a FEV1 of less tha 1.0 l ran a six-fold greater risk of returning with a new attack within 1 month than patients with lower eosinophil count and higher FEV1. No significant correlation was found between post-treatment PEF variation and relapse in acute asthma.

Acute Disease↗
PubMedDate not supplied

[Determination of the eosinophil count in nasal mucus. Comparison of 2 techniques].

We compared swab and scraping (Rhino-probe) technics in the nasal cytology obtention for eosinophils count in 36 patients with a range of 2-46 years old (mean age 18.6 years) with diagnosis of Allergic Rhinitis. The eosinophil count with swab technic was between 0-79 cells with average of 6.5 cells and in the scraping (Rhino-probe) was in a rate of 0-100 cells with a average of 13.4 cells. Of the 36 patients with Rhinitis seen at our clinic, 13 (36%) of positive with swab and 19 (53%) with scraping technics (Rhino-probe) with percent differential of 17%. The comparison between the eosinophils count with both technics was p less than 0.05 for scraping (Rhino-probe) technic.

Adolescent↗