Management of Elevated Eosinophils

Diagnostic Evaluation

The American Gastroenterological Association recommends travel history to identify potential parasitic infections 1
Stool studies including concentrated microscopy and PCR for parasites are essential for diagnostic evaluation 2

The American College of Gastroenterology recommends empiric treatment with albendazole 400 mg single dose plus ivermectin 200 μg/kg single dose for patients with travel history to endemic regions 2
For strongyloidiasis, ivermectin 200 μg/kg daily for 2 days is recommended 2
For ascariasis/hookworm, albendazole 400 mg as a single dose is recommended 2
For schistosomiasis, praziquantel 40 mg/kg in two divided doses for 1 day is recommended 2
The European Society for Pediatric Gastroenterology recommends proton pump inhibitor therapy twice daily for 8-12 weeks for eosinophilic esophagitis 3
Topical steroids are effective for inducing histological and clinical remission in eosinophilic esophagitis 3
A two-food elimination diet (milk +/- wheat or egg) for 8-12 weeks is recommended for dietary management of eosinophilic esophagitis 4

Endoscopy with biopsy is recommended for patients with suspected eosinophilic esophagitis, with at least six biopsies taken from different anatomical sites within the esophagus 5
For patients with eosinophilia and neurological symptoms, exclusion of parasitic infections of the CNS and consideration of corticosteroids is recommended 6
Patients with eosinophilia refractory to treatment and/or with significant concomitant atopic disease should be jointly managed by a specialist team 3

After initiation of therapy, endoscopy with biopsy while on treatment is recommended to assess response in cases of eosinophilic esophagitis 5
Histological response should be classified according to eosinophil density, with remission defined as <15 eosinophils/0.3 mm^2 5
For patients on corticosteroids, monitoring for side effects and consideration of bone and stomach protection measures is recommended 6