As a patient with allergic diseases such as rhinitis and asthma, any doctor with symptoms recommends a blood test, and a specialist will pay special attention to one indicator: eosinophils< /strong>.
A patient with severe asthma-sinusitis
This has always been a hot topic among our asthma patients. Many patients are concerned about whether to intervene in the increase of eosinophils? Some patients are even more worried that increased eosinophils may detect a special disease, thus suggesting a tumor risk?
Professor Xie Jiaxing, currently working at the National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, is an expert in pulmonary eosinophilia and is also an expert on eosinophilic granulomatous polyvascular disease in China. Member of the multidisciplinary expert consensus expert group on the standard of inflammation diagnosis and treatment, we interviewed him on these two issues that everyone is most concerned about.
Why do patients with rhinitis and asthma need to pay special attention to eosinophils in blood test results?
Professor Xie introduced that eosinophils mainly exist in our blood circulation, spleen, lymph nodes, thymus and gastrointestinal tract, respiratory tract and genitourinary tract.
When eosinophil levels are higher than normal in various parts of the body (0.5-1.5 is mildly increased, 1.5-5.0 is moderately increased , ≥ 5.0 is a severe increase), hypereosinophilic diseases will occur, for example, eosinophilic asthma, sinusitis-nasal polyps, eosinophilic granulomatosis-polyangiitis, eczema- Atopic dermatitis, eosinophilic esophagitis, eosinophilic gastroenteritis, eosinophilic syndrome, etc.
Eosinophils are only formed in the bone marrow, and then enter the blood circulation from the bone marrow to their final destination (respiratory tract, gastrointestinal tract, etc.) It does not exceed half a day, but in our bronchial mucosa and nasal mucosa, it stays there for a long time, possibly up to 2 weeks.
This is why some patients with asthma or allergic rhinitis not only need to check blood eosinophils, but also sometimes need to check for induced sputum (induced sputum by inhalation of aerosolized hypertonic saline) sputum production and further analysis of inflammation in sputum), because sometimes normal blood eosinophils do not mean that the number of eosinophils in the respiratory tract is normal, many times from sputum or nasal secretions collected from patients A large number of eosinophils can be found.
Eosinophils, a special type of white blood cell in the human immune system, are involved in many inflammatory processes, especially allergic diseases, In simple terms, when our body is exposed to an allergy-triggering food or an airborne allergen, eosinophils respond by entering the area and releasing various toxins, killing pathogens, killing Parasite, involved in allergic reactions and regulating inflammatory responses.
Normal people have few eosinophils in their blood, but when the body’s immune balance is disturbed and too many eosinophils are produced, they can Being activated and releasing too many toxic substances causes chronic inflammation (not inflammation of bacterial infection as it is usually said), which leads to tissue damage, food allergies or rhinitis-asthma.
Should I intervene for increased eosinophilia?
Professor Xie introduced that generally speaking, the higher the eosinophils, the more severe the patient’s rhinitis and asthma symptoms, and the more prone to acute attacks. This is for sure.
However, there will indeed be a small number of patients with high blood eosinophils but not serious rhinitis and asthma, or very serious rhinitis and asthma, but their blood eosinophils are not high. For patients with low blood eosinophils but severe rhinitis and asthma, most of them are taking hormone therapy to suppress eosinophils, but you can still find eosinophils in the airways when you check their induced sputum. Acid is high.
The long-term indication for some blood eosinophilia or induced sputum examination is high, but the rhinitis and asthma are not serious, it may be caused by other diseases, such as combined Parasitic infection. If his symptoms are well controlled and his lung function tests are stable, other causes of eosinophilia should be searched for. If no cause can be found, long-term follow-up can be performed. It is not necessary to treat eosinophilia. Granulocytes decreased to normal.
How to reduce the increase of blood eosinophils in patients with rhinitis-sinusitis-asthma?
Generally speaking, after standard and systematic treatment, the condition will gradually improve, the symptoms will be controlled and the inflammation will disappear naturally. However, for some severe rhinitis-asthma patients, a large amount of hormones may be needed to lower the symptoms, and targeted biological targeted drugs may be required. However, as the patient said, this type of targeted drug is relatively expensive. Currently, it is not covered by medical insurance. You can choose it according to your actual situation. these targeted drugs.
Is chronically elevated eosinophils really at risk of cancer?
Professor Xie introduced that there is currently no such evidence that the two are directly related, and patients must not scare themselves. According to the current research, eosinophils may be a protective factor or a predisposing factor for tumors. There is no conclusion at present, and even according to previous research, eosinophils may also have a protective effect.
As for the eosinophilic granulomatous vasculitis that the patient asked about, strictly speaking, it is a rheumatic immune disease and a systemic vasculitis Diseases can affect the whole body, and the most important ones are our nose, lungs, digestive tract, and heart. The main feature is that blood routine eosinophils are very high. Asthma is the most important clinical feature in the early stage. Most patients also have chronic sinusitis-nasal polyps and other upper airway symptoms and extremity numbness and other nerves. Systemic symptoms, The main treatment method is the same as that of severe asthma complicated with sinusitis, and the new biological targeted drug treatment for eosinophils that we just mentioned can also be considered.
However, most of the current clinical diagnosis of such diseases are only early clinical inferences. Few of the diseased tissues, especially the arteries, are actually biopsied and confirmed by pathology.More Most of them are severe eosinophilic asthma, and most importantly, even if they are diagnosed with early eosinophilic granulomatous vasculitis, the treatment methods are basically the same.
Finally, Prof. Xie also emphasized that for eosinophilia, we can neither miss serious cases nor overdiagnose and treat them.