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A.
Eosinophils are white cells that are produced by the bone marrow. More than 500 eosinophils per cubic millimetre of blood is abnormal, and is called eosinophilia; this number usually amounts to more than 8% of all white cells. In general eosinophilia arises as a response to parasites (such as filaria or helminths), or from allergy as occurs with asthma and allergic rhinitis, or in some gastrointestinal disorders that may be associated with food allergy. A few drugs or inhaled allergens can cause inflammatory tissue changes accompanied by eosinophilia in susceptible people.
In tropical countries like India, parasites are a common cause of eosinophilia, and there is often an association with asthma.In occasional patients, an idiopathic hypereosinophilic syndrome occurs, with an eosinophil count in excess of 1500 cells per cubic millimeter of blood, and the heart or nervous system may be affected. Other causes that may be responsible for eosinophilia include collagen-vascular diseases or skin diseases such as pemphigus. Thus, there are numerous rare causes of eosinophilia to consider, although sometimes there is no obvious disease in some people who have prolonged persistence of the high eosinophil count. It is not unusual for the abnormality to eventually clear up without treatment.
It is probable that you have an allergic condition, with a component of asthma; this could be caused by parasites. Specific treatment for a parasite would necessitate first identifying the cause from a stool specimen, or from a blood specimen taken if there is fever. If no abnormalities are found on a thorough physical exam, then no other tests may be indicated, although sometimes a biopsy of an involved organ may be appropriate. When there is evidence of skin allergy or asthma, it is usually necessary to use drug therapy. The first line of treatment would be antihistamines. The next to be considered would be oral corticosteroids. For predominant asthma, a trial for several weeks of an inhaled steroid or of sodium chromoglycate or nedocromil would be appropriate along with an inhaled bronchodilator such as albuterol.
In summary, it appears that your eosinophilia is due to an allergy. An effort should be made to determine the cause, so that specific therapy can be given. In that case, inhaled steroids and other asthma drugs should be tried. It is possible that a course of oral steroids may improve the condition if other forms of treatment fail. However, if the condition has improved over the past year, it may be worth waiting to see if further reduction in symptoms will occur without specific treatment.
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