Eosinophilic pneumonias

• Published in: Allergy (Copenhagen) Vol. 60; no. 7; pp. 841 - 857
• Main Authors: Cottin, V., Cordier, J.‐F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01.07.2005; Blackwell; Blackwell Publishing Ltd; Wiley
• Subjects: Adrenal Cortex Hormones - therapeutic use; allergic bronchopulmonary aspergillosis; Allergic diseases; Biological and medical sciences; Churg-Strauss Syndrome - diagnosis; Churg-Strauss Syndrome - physiopathology; Churg-Strauss Syndrome - therapy; Churg–Strauss syndrome; eosinophil; Eosinophils - physiology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Immunosuppressive Agents - therapeutic use; Leukocytes; Life Sciences; Medical sciences; Medical treatment; Pneumonia; Pulmonary Eosinophilia - diagnosis; Pulmonary Eosinophilia - physiopathology; Pulmonary Eosinophilia - therapy; Respiratory diseases; Granulomatous vasculitis; Immunopathology; Lung disease; Allergy; Churg Strauss syndrome; Pneumonia; Mycosis; Respiratory disease; Granulocyte; Cardiovascular disease; allergic bronchopulmonary aspergillosis; Bronchopulmonary; Eosinophil; Infection; Vascular disease; Churg-Strauss syndrome; Immunology; Eosinophilic pneumonia; Aspergillosis; ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS; CHURG–STRAUSS SYNDROME; PNEUMONIA; EOSINOPHIL
• ISSN: 0105-4538; 1398-9995
• DOI: 10.1111/j.1398-9995.2005.00812.x

Eosinophilic pneumonias (EP) encompass a wide spectrum of lung diseases characterized by peripheral blood eosinophilia (>1 × 109 eosinophils/l) and/or alveolar eosinophilia (>25%). Blood eosinophilia may be lacking, as in the early phase of idiopathic acute EP, or in patients already taking oral corticosteroids. EP may present with varying severity, ranging from almost asymptomatic infiltrates to the acute respiratory distress syndrome necessitating mechanical ventilation. Possible causes of EP must be thoroughly investigated, especially drugs and the variety of parasitic infections (considering history of travel or residence in areas of endemic parasitic infection). However, chronic EP remains idiopathic in many cases. When present, extrathoracic manifestations lead to suspect Churg–Strauss syndrome (CSS) or the hypereosinophilic syndrome (HES), the prognosis of which is dominated by cardiac involvement. Apart from the treatment of specific causes when possible, corticosteroids remain the cornerstone of symptomatic treatment for eosinophilic disorders, usually with a dramatic response, but frequent relapses when tapering or after stopping the treatment. The adjunction of immunosuppressants to corticosteroids is necessary in patients with CSS and poor prognosis factors. Imatinib has recently proven effective in the treatment of the myeloproliferative variant of the HES.