Eosinophilia

Eosinophilia refers to a chronic health condition resulting due to the presence of excessive eosinophils (a type of white blood cell) in blood or body tissues. Eosinophils are produced in the bone marrow and exist normally in the bloodstream and gut lining, which helps the body fight infection due to microbes, parasites or any such harmful foreign agents. On an average, around 5% to 7% of white blood cells constitute eosinophils but if you have a higher count then it means that you either have borderline eosinophilia or actual progressing eosinophilia that can cause significant health hazards. If diagnosed in time and treated in a proper fashion, this disorder is curable in most cases and affected persons can lead a normal life.

As we proceed towards Uttarayana when the sun’s heat is felt strongly by us, the body exudes excess fluids causing various allergic reactions which manifests in sneezing, cough, rashes, fevers, etc. Such symptoms are also caused due to enhanced levels of eosinophils in our blood.

A type of eosinophilia is Tropical (pulmonary) eosinophilia or TPE. It is characterized by coughing, asthmatic attacks and an enlarged spleen. It is observed that in this type the eosinophil count is 15-20%. TPE occurs most frequently in India and Southeast Asia. This has been found to be a result of filarial parasitic infections and subside when treated for the same.

Symptoms of Eosinophilia

As a high eosinophils count is the cause for a chain of reactions in the body, there are no specific symptoms related to this condition. But there are several causes due to which you may have a raised count. The reason that these eosinophilia symptoms are generic is because they may be caused to less serious health issues, unrelated to eosinophilia. More often than not, the symptoms of eosinophilia are those of the underlying condition.

Eosinophilia due to asthma:

  • Wheezing
  • Difficulty breathing

Eosinophilia due to parasitic infection:

  • Abdominal pain
  • Diarrhea
  • Fever
  • Cough
  • Skin rashes

Eosinophilia due to allergic reaction to medicine:

  • Skin rashes

Rare symptoms that could signal eosinophilia:

  • Rapid weight loss
  • Night sweats
  • Lymph node inflammation
  • Numbness and tingling in the nerves
  • Mouth sores
  • Abscesses

Causes of Eosinophilia

Our immune system uses white blood cells like eosinophils in fighting off infection-causing bacteria and viruses. When the body wants to attack a substance, such as an allergy-triggering food or airborne allergen, eosinophils respond by moving into the area and releasing a variety of toxins. Eosinophils are found in the spleen and lymph nodes which play a major role in our immunity. These are areas which constitute the Kapha dosha; the aggravation of this dosha causes symptoms like asthma, wheezing, runny nose, etc.

However, when the body produces too many eosinophils, they can cause chronic inflammation resulting in tissue damage which are associated with Pitta dosha. Rashes, itches, dermatitis, burning sensation, fevers and digestive disorders are associated with Pitta.

Eosinophilic disorders are also diagnosed according to the location where the levels of eosinophils are elevated:

  • Eosinophilic esophagitis (esophagus)
  • Eosinophilic gastritis (stomach)
  • Eosinophilic enteritis (small intestine)
  • Eosinophilic colitis (large intestine)
  • Hypereosinophilic syndrome (blood and any organ)

Certain causes which trigger the overproduction of eosinophils are:
– Excessive intake of sweet and heavy unctuous foods, sour or hot preparations and meat
– Dosha vitiating foods like peanuts, seafood, curds, etc.
– Sleeping during the day
– Constipation
– Exposure to cold winds or excessive sunlight and heat.

An increase in eosinophils, i.e., the presence of more than 500 eosinophils/microliter of blood is called eosinophilia, and is typically seen in people with a

  • parasitic or helminthic infestation in their intestines
  • chronic diseases like rheumatoid arthritis
  • malignant diseases such as Hodgkin’s disease
  • skin diseases like dermatitis
  • Addison’s disease
  • reflux esophagitis (in which eosinophils will be found in the squamous epithelium of the esophagus)
  • eosinophilic esophagitis
  • SLE – systemic lupus erythematosus

This is a syndrome consisting of:
severe fatigue
joint pain
joint swelling
headaches
a rash on the cheeks and nose, which is called a “butterfly rash”
hair loss
anemia
blood-clotting problems
fingers turning white or blue and tingling when cold, which is known as Raynaud’s phenomenon

Elevated eosinophils can also be produced with the use of certain drugs such as penicillin.
Perhaps the most common cause for eosinophilia is an allergic condition such as asthma which could be a result of pollen, dust, or any foreign agent that the body treats as an allergen.

Eosinophilia in children is more difficult to diagnose as the range of probable causes is much wider in this case as compared to adults.

Diagnosis of Eosinophilia

Complete Blood Count: The primary way to diagnose the presence of excess eosinophils in the blood is via a Complete Blood Count (CBC) test. This involves taking a simple blood sample and analyzing it under a microscope to detect eosinophilia.

Bronchoscopy: This test is used to diagnose pulmonary eosinophilia. For this test, a bronchoscope (a thin, flexible tube fitted with a camera) is inserted into the esophagus or food pipe through the mouth. The camera checks the lung tissue and helps obtain some tissue for analysis. In case of pulmonary eosinophilia, the lung tissue will display higher number of eosinophils.

Chest X-Ray: A chest x-ray displays pulmonary eosinophilia by showing any abnormal shadows (infiltrates) in the lungs.

Sputum Analysis: If the doctor suspects that the eosinophilia is being caused by a parasitic infection, the patient’s sputum is analyzed under a microscope to check for parasitic worms or their larvae.

Endoscopy (EDG): During this procedure, a flexible tube with a camera fitted on one end is inserted through the mouth into the esophagus. Those who have eosinophilic esophagitis will have a narrow esophagus. While others may have abnormal rings of tissue along the esophageal tube (resembling a Schatzki ring). If the doctor suspects eosinophilia, s/he will confirm the diagnosis with a biopsy.

Biopsy: A small tissue sample is extracted with the help of long, thin biopsy forceps. This tissue is then analyzed for the occurrence of eosinophils.

Lumbar Puncture: A lumbar puncture or a spinal tap can help determine whether there is an elevated number of eosinophils. To do this, a local anesthetic is administered to the lower back. Then, a small amount of fluid is extracted from the space between the third and fourth vertebrae. This is examined under a microscope to render a diagnosis.

Investigations of Eosinophilia

Investigation is a systematic review guided by the history, examination and clinical picture. It may include any of the following factors:

Allergy

A past episode(s) of hay fever, eczema, asthma or urticaria should be further investigated.

Geographic factors

Living in or travelling to an area rife with parasitic infestation or coccidioidomycosis is cause for concern.
If the patient has resided in or traveled to a tropical area, they should be examined for the exposure to soil or water and any symptoms that signal parasitic disease.

One must take into account all travel experiences (not necessarily only recent ones) as strongyloidiasis may show itself decades after leaving their natural habitat, particularly during periods of low immunity.

HIV infection

HIV-positive people have a higher likelihood to have disseminated parasitic or fungal infections that could lead to eosinophilia.

Drug history

  • The doctor will need details on drug history (especially non-prescription drugs, newly started drugs [usually started within 2-6 weeks] and immunosuppressive drugs).
  • Corticosteroids or other immunosuppressive agents are the ones to watch for as they could mean that the immunosuppressive treatment could have resulted in hyperinfestation with Strongyloides stercoralis.
  • Drugs usually associated with adverse reactions (e.g., sulphonamides, cephalosporins, penicillin, nitrofurantoin, carbamazepine, allopurinol, phenytoin, or gold) should be noted. Fever, rash, lymphadenopathy and impaired liver function tests may point towards an adverse drug reaction.

History of rash or lymphadenopathy

Previous rash or lymphadenopathy is pertinent, not only in relation to a drug reaction but also to primary skin diseases that are causative in eosinophilia. Leukemia, lymphoma or systemic mastocytosis are all causes of both a rash and lymphadenopathy.

Cardiac history

Cardiac symptoms (e.g., dyspnea, chest pain, palpitations) with marked or prolonged eosinophilia could indicate cardiac damage by eosinophils. Eosinophilic cardiac disease is a clinically urgent condition.

Other organ-related symptoms

Specific organ systems may indicate symptoms that indicate an inflammatory disorder, such as dysphagia in eosinophilic esophagitis, or abdominal pain and diarrhea in eosinophilic gastroenteritis.

Symptoms of lymphoma

Fever, night sweats, weight loss, itch and alcohol-induced pain are all possible symptoms of lymphoma.

Episodic symptoms

Symptoms such as episodic weight gain and episodic angioedema should be looked into, as they occur in the rare disorder of Gleich’s syndrome (episodic angioedema with eosinophilia).

Home Remedies for Eosinophilia

Kindly avoid the usage of steroids to battle the infection unless in an emergency. If you want to know how to bring down eosinophils count, try building up immunity through a suitable lifestyle plan. The following simple natural remedies are also

  • Regular intake of fresh Amlaki juice with some raw turmeric can boosts your body’s resistance power.
  • The traditional habit of eating bitter neem leaves helps balance the aggravated phlegm (Kapha dosha).
  • Undergoing the Vamana procedure for cleansing toxins helps give much relief in such cases.
  • Avoid fruits like banana, custard apple or mango in excess.
  • Restrict milk and milk products.
  • Sour or fermented foods are a sure shot way to increase those symptoms, hence better avoided.
  • Preferable consumption of sweets before meals helps digest the sweet without increasing phlegm and pacifying bile. Also, this helps digest the sweet better so there is minimal gain of fat.
  • Black pepper is very effective for eosinophilia. Add a teaspoon of honey to a pinch of black pepper powder.
  • Mix this in a glass of lukewarm water (not above 40°C). Drink this water twice daily.
  • Steam inhalation with eucalyptus oil can be very effective in clearing the nasal passages of mucus.

Eosinophilia Treatment in Ayurveda

Herbs
  • Kapur Kachri (Hedychium spicatum): Kapur Kachri or Spiked ginger lily is very beneficial for Kapha-related respiratory problems. The powder is taken in doses of 1-3 gms daily to lower eosinophil count.
  • Turmeric (Curcuma Longa): This is a common kitchen spice that is anti-inflammatory and anti-allergic in nature. One can burn a piece of dried turmeric root in direct flame and inhale the fumes for immediate relief. A piece of turmeric root can also be fried slightly in ghee (clarified butter) and then mixed in a cup of warm milk.
  • Licorice (Glycyrrhiza Glabra): Eosinophilic esophagitis is an inflammation of the esophagus or food pipe due to a build-up of eosinophils in the esophageal tissue. Take 1 tsp of licorice root powder mixed with 1 tsp unpasteurized honey to soothe reflux-like symptoms.
  • Bharangi (Clerodendron Serratum): Prepare decoction of its root and drink one teaspoon twice a day for three days to get relief from asthma, bronchitis and other respiratory issues.
  • Pippali (Piper Longum): Take about 10 gms each of dried ginger or saunth, holy basil (tulsi) leaves and long pepper. Add 4-6 cardamoms and grind into a fine powder. Take this powder with an equal amount of honey to relieve cough and congestion.
  • Neem (Azadirachta Indica): Take a spoonful of neem leaf juice after meals. Neem pacifies both Pitta and Kapha. It also acts as an antiseptic agent and it is very effective in fighting infections in the body and purifying blood.
  • Vasa (Adhathoda Vasica): This is another herb that is very beneficial for respiratory problems. Vasa has the ability to dissolve mucus, ease cough and in general, repairs the whole respiratory tract. It targets both Pitta and Kapha dosha. Take one teaspoon of the juice after meals for at least a week to see results.
Ayurvedic Supplements (to be taken under physician’s guidance – Consult Now) Chyawanprash Special

Sitopaladi Churna

Swashkuthar Ras

Vasavaleyha

Vasarishtha

Talisadi Churna

Pipalyasava

Diet and Lifestyle
  • Patients may adopt a well-balanced diet, with emphasis on raw vegetables and fruit juices. Fruits increase Kapha and Pitta hence a complete fruit diet may not always be the right solution as part of your eosinophilia diet.
  • Likewise, one needs to avoid any kind of foods which can cause allergy in body. Avoid milk products, ghee, egg, red meat, etc.
  • Boiled karela (bitter melon), raw banana, okra, squash and all types of gourds are easy to digest and alleviate the symptoms.
  • In eosinophilic esophagitis, there may be an inflamed esophagus or food pipe. In case of esophagus problems, one must not consume foods that may cause heartburn as they might worsen the symptoms. This means eating foods that are highly acidic or fatty in nature. Stay away from caffeinated beverages, alcohol, fried foods, spicy sauces, etc.
  • It is also a good idea to steer clear of allergens if you have bouts of eosinophilia. Dust, pollen, dander from pets and birds (pigeons), perfumes, room fresheners, bedbugs, etc. can all set off an allergic reaction in those who are prone to breathlessness and other respiratory problems.
Yoga
  • Pranayam – Ujjayi, Kapalbhati, Bhastrika and Nadi-shodhan (upto third stage)
  • Sun Salutation (Surya Namaskara)
  • Meditation
  • Wheel Pose (Chakrasana)
  • Camel Pose (Ushtrasana)

Note: Pranayama and Yoga should be performed judiciously as certain types like Kapaal Bhaati might aggravate the disease. Balancing the solar plexus through Mandukasana helps in such cases.