Secondary causes of hypereosinophilia
| Category . | Examples (not inclusive) . |
|---|---|
| Allergic disorders* | Asthma, atopic dermatitis |
| Drug hypersensitivity | Varied† |
| Infection | |
| Helminthic | Varied, including strongyloidiasis, trichinellosis, filariasis, schistosomiasis, hookworm |
| Ectoparasite | Scabies, myiasis |
| Protozoan | Isosporiasis, sarcocystis myositis |
| Fungal | Coccidiomycosis, allergic bronchopulmonary aspergillosis, histoplasmosis |
| Viral | HIV |
| Neoplasms | Leukemia, lymphoma, adenocarcinoma |
| Immunologic disorders‡ | |
| Immunodeficiency | DOCK8 deficiency, hyper-IgE syndrome, Omenn’s syndrome |
| Autoimmune and idiopathic | Sarcoidosis, inflammatory bowel disease, IgG4 disease, and other connective tissue disorders |
| Miscellaneous | Radiation exposure, cholesterol emboli, hypoadrenalism, IL-2 therapy |
| Category . | Examples (not inclusive) . |
|---|---|
| Allergic disorders* | Asthma, atopic dermatitis |
| Drug hypersensitivity | Varied† |
| Infection | |
| Helminthic | Varied, including strongyloidiasis, trichinellosis, filariasis, schistosomiasis, hookworm |
| Ectoparasite | Scabies, myiasis |
| Protozoan | Isosporiasis, sarcocystis myositis |
| Fungal | Coccidiomycosis, allergic bronchopulmonary aspergillosis, histoplasmosis |
| Viral | HIV |
| Neoplasms | Leukemia, lymphoma, adenocarcinoma |
| Immunologic disorders‡ | |
| Immunodeficiency | DOCK8 deficiency, hyper-IgE syndrome, Omenn’s syndrome |
| Autoimmune and idiopathic | Sarcoidosis, inflammatory bowel disease, IgG4 disease, and other connective tissue disorders |
| Miscellaneous | Radiation exposure, cholesterol emboli, hypoadrenalism, IL-2 therapy |
IgE, immunoglobulin E; IgG4, immunoglobulin G4; IL-2, interleukin-2. Adapted from Klion4 with permission.
Allergic disorders, including asthma and atopic dermatitis, can be associated with AEC ≥ 1500/μL, especially in children, although extremely high eosinophil counts (AEC ≥ 5000/μL) should prompt consideration of another cause. Because allergic manifestations are common in patients with idiopathic HES and LHES, the distinction between allergic disease with marked eosinophilia and HES with concomitant allergic disease may be impossible in some cases.
Drug hypersensitivity can occur in response to any prescription or nonprescription drug or supplement. Although drug-associated eosinophilia can be asymptomatic, well-described syndromes include eosinophilia-myalgia syndrome, drug reaction with eosinophilia and systemic symptoms, interstitial nephritis, and eosinophilic hepatitis.
Hypereosinophilia can occur in the setting of a wide variety of immunologic disorders, particularly those characterized by lymphocyte dysregulation. Clinical sequelae of eosinophilia may or may not be present and can be difficult to distinguish from manifestations of the underlying disorder.