Not everyone has a favorite type of white blood cell, but I sure do. Eosinophils have always been my favorite. If I see them elevated on the differential, I am usually less worried than when there are other elevations in different types of white blood cells. Neutrophils worry me about a significant infection and lymphocytes are even worse.
Eosinophils help in many ways from trapping substances, killing cells, bactericidal activity and even anti-parasitic activity. But usually, it just means that you are a highly allergic person. Often these patients have 1 or all of the allergic triad. The allergic triad consists of allergic rhinitis, asthma and atopic dermatitis.
I have had allergies for years and so I realize that my bone marrow is working hard right now making eosinophils. Runny noses, sneezing, scratchy throat, itching eyes and post-nasal drip are all symptoms that may be coming from these eosinophils. I cannot even spend time with someone that has cats due to my allergies. They set my eosinophils on fire. I once had to end a relationship with a girlfriend (that had a cat) over allergy issues.
Asthma is a common respiratory condition that can be associated with eosinophils. Asthma causes inflammation and bronchoconstriction in airways. There are some new medicines that specifically treat allergic asthma. These patients often have to get their IgE levels checked. This is a way of checking your immunoglobulin levels associated with eosinophils. Attacking the eosinophils has lead to big changes for some patients with asthma.
Ivermectin has become an infamous medication over the past few months. But it has been used in the past to treat certain parasites. Both strongyloidiasis and river blindness are treated with ivermectin. Why is this relevant? Because parasites cause eosinophils to rise.
But now we are seeing more eosinophilic esophagitis. This is a condition that was first diagnosed in the 1980s. This causes esophageal impaction, abdominal pain and even food refusal at times. This has been diagnosed more and more over the past few years. Patients with this condition often have food allergies that lead to this food impaction and gastrointestinal symptoms. These classic symptoms along with more than 15 eosinophils per high power field is how the diagnosis is made.
Now that I have thought about all the issues that are associated with eosinophils, I am going to rethink my favorite type of white blood cells. Maybe it is time for me to move my love to monocytes. But if not for eosinophils and the reaction I had to cats maybe I would not have met my wife. Which lead to me having my children. This is a thank you to my eosinophils. If they were not as responsive in my life who knows where I would be in life. Thank you Eosinophils.
The Doc is In
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