Eosinophilia and EoE Flashcards
1
Q
Criteria for Hypereosinophilic Syndrome
A
- Eos > 1500/ml
- End organ dysfunction
- No other etiologies identified
2
Q
EGPA Criteria
A
ACR Classification requires 4/6
- asthma
- sinus abnormality
- migratory or transient pulmonary opacities
- mononeuropathy or polyneuropathy
- > 10% of eos on diff
- biopsy showing eos infiltrate in a blood vessel
3
Q
What is the 5 factor score?
A
Scoring for EGPA
- Age >65
- Myocardial involvement
- Renal insuff.
- GI involvement
- Absence of ENT manifestations (presence is associated with better prognosis)
4
Q
Treatment of EGPA
A
- Systemic steroids
- FFS>/= 2 or FFS of 1 if CV or CNS involvement try cyclophosphamide
- For maintenance: Aziathioprine, MTX, LEF
- For refractory cases: Ritux or Mepolizumab
5
Q
Pathophysiology of EoE
A
- elevated levels of Th2 cytokines IL-4, IL-5, IL-13 and mast cells (which recruit cytokines and eos)
6
Q
Features on endoscopy for EoE
A
- Linear furrowing
- Concentric rings
- Speckled exudate
- small calibre esophagus
- mucosal tears
7
Q
Allergy assessment in EoE. Should it be done?
A
- SPT and sIgE can be considered
- AAAAI suggests allergy testing based elimination diet over no treatment
- no stat. sig for patch testing
- consider aeroallergen testing
- 10-30% of patients have IgE food allergies
- Use testing to expand a restricted diet
8
Q
Treatment options for EoE
A
- Elemental diet, followed by re-intro of 1 food per week starting with less allergenic foods and then the most allergenic foods. alt option: cows milk elim., 6 food elim, 4 food elim
- Topical CS: Budesonide 1000-2000ug/day, fluticasone prop. 500-1000ug/day
- Biologics - Dupixent approved FDA 2020
- Mechanical dilation
9
Q
Categorizing hypereosinophilia
A
- Myeloproliferative - PDGFRA1/FGFR/JAK2
- Lymphoproliferative - CD3+CD4-
- Famililal
- Unknown
- Associated - with IBD or AI conditions
10
Q
List 4 beneficial functions of Eos
A
- Helminth defence
- Adaptive immune system modulation
- Tissue repair
- tumour surveillance
- maintain GI barrier integrity
- support survival of plasma cells
11
Q
Differences between GERD and EE
A
GERD
- presents later in life
- more likely to respond to PPI
EE
- associated with food allergies
- has characteristic features on endoscopy like linear furrowing, concentric rings, small calibre esophagus and exudates
- clinical features are dysphagia and food impaction
