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Hypereosinophilia in Children and Adults: A Retrospective Comparison
#MMPMID27130711
Williams KW
; Ware J
; Abiodun A
; Holland-Thomas NC
; Khoury P
; Klion AD
J Allergy Clin Immunol Pract
2016[Sep]; 4
(5
): 941-947.e1
PMID27130711
show ga
BACKGROUND: The differential diagnosis of hypereosinophilia is broad and includes
asthma, atopic disease, drug hypersensitivity, parasitic infection, connective
tissue disorders, malignancy, and rare hypereosinophilic disorders.
Hypereosinophilia in children has not been well characterized to date. OBJECTIVE:
The objective of this study was to identify the common causes of marked
eosinophilia in children and to characterize and compare the clinical symptoms at
presentation, laboratory findings, final diagnosis, and therapeutic responses
between children and adults with hypereosinophilic syndromes. METHODS: A
retrospective analysis of consecutive subjects evaluated for unexplained
eosinophilia ? 1.5 × 10(9)/L was conducted. All subjects underwent standardized
clinical and laboratory evaluations with yearly follow-up. Clinical and
laboratory parameters, final diagnoses, treatment responses, and outcomes were
assessed. Medians and proportions were compared using Mann-Whitney U and Fisher
Exact tests, respectively. RESULTS: Of the 291 subjects evaluated, 37 (13%) were
children and 254 were adults (87%). Whereas the frequencies of clinical
hypereosinophilic syndrome (HES) variants were similar between children and
adults, primary immunodeficiency was a more common secondary cause of HES in
children (5% vs 0.4% in adults). Excluding subjects with treatable secondary
causes, the median peak absolute eosinophil count was increased in pediatric
subjects (9376 vs 5543/?L; P = .002), and children had more gastrointestinal
complaints (62% vs 34%; P = .003) and less pulmonary involvement (34% vs 59%; P =
.01) than adults. Despite these differences, corticosteroid responsiveness and
overall prognosis were similar between the 2 groups. CONCLUSIONS: Although
children with HES often present with higher peak eosinophil counts than adults,
the differential diagnosis, clinical characteristics, and prognosis of HES are
similar in the 2 groups.
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