Eosinophils are innate immune leukocytes recruited in large numbers to sites of allergic inflammation and parasitic infections. Recent studies show additional pleiotropic effects of recruited eosinophils impacting immunomodulation, tissue homeostasis and repair. Pathologic conditions accompanied by blood eosinophilia are quite frequent in medical practice and may raise serious differential diagnosis problems in severe cases, that require a multidisciplinary approach. Hypereosinophilia may be reactive to other diseases or primary, representing hypereosinophilic syndromes, that are diagnosed based on clinical and laboratory criteria, according to actual international guidelines. The etiopathogenic diagnosis is difficult and delayed in many cases and clinical evolution may be severe, with multiorgan involvement and poor prognosis. Some cases remain idiopathic, despite exhaustive investigation. This paper aims to review the most recent data in the literature referring to the role of eosinophils in human pathology, diagnostic criteria and treatment strategies of hypereosinophilic syndromes, actual classification and to draw some useful recommendations in clinical practice.
Allergic diseases represent an important health problem in the most of developed countries, due to continuous increasing prevalence, with significant individual and social consequences. Allergic diseases may raise serious problems in clinical practice, derived from complexity of clinical forms and mechanisms and from rising incidence of severe cases, with high fatality risk. Taking into consideration the dramatic increase of all allergies forms during the last decades, they are considered a real “epidemic” of the XXIst century, being classified by the World Health Organization as the fourth most frequent chronic diseases. The European authorities pay more attention to allergic diseases in last years and discuss the actual situation of the allergology specialty in different countries, with the aim of harmonization and improvement of medical assistance in this field. The aim of this paper is presentation of some relevant aspects of allergology specialty and practice in our country in the actual European context, mainly unmet needs and difficulties, taking into consideration recommendations and priorities recently issued by European authorities. We hope for a better recognition of the specialty and improved interdisciplinary collaboration.
We report a case of a 69-year-old woman who is followed since seven years for persistent blood hypereosinophilia up to 5100/mmc. She has been extensively investigated for other diseases known to induce hypereosinophilia, including allergies, parasitic infections and neoplasia. No end-organ dysfunction could be confirmed. We considered a possible primary hypereosinophilic syndrome (HES) and determined the genetic mutation FIP1L1-PDGFRA characteristic for HES, which was negative.
Bone marrow showed reactive eosinophilia with no malignant cells and rare mast cells, less than 15 in aggregates, which is the major criterion for diagnosing mastocytosis. Knowing the association between HES and mastocytosis, we measured and found high serum tryptase levels and positive c-kit D816V genetic mutation, characteristic for systemic mastocytosis. The patient was closely monitored, with regular hematologic and clinical evaluation, mainly for cardiac and neurologic manifestations.
A short trial of high dose corticotherapy induced remission of hypereosinophilia, but this could not be maintained with lower doses. The clinical outcome during follow-up period was rather good, except mild cognitive decline and atrial fibrillation.The reported case is illustrative for versatile presentation and difficulties in management of hypereosinophilia in clinical practice.
Polliana Mihaela Leru, Ana-Maria Eftimie and Michel Thibaudon
Introduction. Respiratory allergies induced by allergenic plants pollen represent an important public health problem with increasing prevalence and severity. Aerobiologic study of allergenic pollens is performed in many countries on regular basis and correlated with health data from allergists in the frame of national aerobiology networks. Romania has no aerobiology network and pollen measurements have been done between 1999-2012 in West region only. In the frame of COST Action called Sustainable management of Ambrosia artemisiifolia in Europe (SMARTER FA 1203), three years collaboration with Reseau National de Surveillance Aerobiologique (RNSA) from France and the first pollen monitoring center in Bucharest were established.The aim of this paper is to present results of first pollen monitoring in Bucharest, activities of Romanian SMARTER group and collaboration with European aerobiology specialists.
Material and method. We used a Hirst-type pollen trap placed on the roof of the Research Center from “Colentina” Clinical Hospital and the pollen monitoring method based on European Aeroallergen Network (EAN) standardized requirements. Monthly results during the pollen seasons 2014-2016 were sent to RNSA and EAN and posted on the European pollen information site.
Results. We found high amounts of allergenic pollen, mainly grasses from May to September and Ambrosia artemisiifolia during September.
Conlcusions. We concluded that SMARTER offered access to aerobiology training, improved multidisciplinary collaboration and perspectives to further develop national and international projects. More coordinated efforts to develop national aerobiology network and to recuperate the gap comparing to other European countries in the field of aerobiology and respiratory allergology are needed.