Drug-Induced Eosinophilia

High-Risk Medication Classes

• The American Academy of Allergy, Asthma, and Immunology recommends that NSAIDs (particularly ibuprofen, naproxen, and celecoxib), beta-lactam antibiotics, nitrofurantoin, anticonvulsants (especially phenytoin), and sulfonamide-containing antibiotics be considered as the most common medication classes that cause eosinophilia 1, 2
• Oxicam derivatives (meloxicam, piroxicam) and acetic acid NSAIDs (diclofenac) have higher associations with severe cutaneous adverse drug reactions including DRESS syndrome, according to the Journal of Allergy and Clinical Immunology 1

Clinical Presentation and Management

• The American College of Clinical Pharmacology notes that beta-lactam antibiotics are common causes of drug-induced eosinophilia 2
• Any patient with eosinophilia and evidence of end-organ damage requires urgent medical evaluation, as stated by the Praxis Medical Insights 3
• Do not assume eosinophilia is drug-related without first excluding helminthic infections, especially in travelers or migrants, according to the Praxis Medical Insights 3, 2
• The Journal of Allergy and Clinical Immunology warns that ibuprofen is frequently falsely implicated in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) cases due to protopathic effect 1