Eosinophilia attention, diagnosis, treatment, and awareness in physicians: a cross-sectional survey

Abstract

Background: Patients with incidental eosinophilia is becoming increasingly common in clinical practice. But it remains challenging to diagnose and treat owing to its complex etiology. The awareness of physicians and the strategies of diagnosis and treatment toward eosinophilia are still unclear. Objective: We aimed to evaluate attention, diagnosis, treatment, and awareness of eosinophilia among physicians, as well as factors influencing clinical practice, and to find ways to improve the efficacy of this disease. Design: This is a cross-sectional survey. Methods: A cross-sectional study was conducted from 1 to 4 June 2021 in a tertiary hospital. Self-administered and validated electronic questionnaire was used to investigate the attention toward eosinophilia, the strategies of diagnosis and treatment, and the awareness in physicians. Results: A total of 607 valid questionnaires were collected, with a response rate of 84.5%. Among the responders, 65.4% of physicians claimed to be familiar with patients with eosinophilia but only 11.0% of them had read the relevant guidelines or expert consensus. Among 207 physicians who had ever diagnosed patients with eosinophilia, only 19.4% had performed detailed examinations. The accuracy of awareness questions was 1.6–53.5%, and only 26.5% of physicians had high levels of awareness. An increase in the awareness level of up to 2.82 folds was seen among physicians with factors such as job title, encountering patients with eosinophilia, linking patients’ conditions to peripheral blood eosinophil count, and paying attention to guidelines. Conclusion: This study highlighted the importance of raising awareness and knowledge of eosinophilia among physicians in China. More works on education about eosinophilia guideline are needed, which may help physicians make decision with more benefits to patients.

The multidisciplinary approach to eosinophilia

“…Moderate or severe eosinophilia is a risk factor for a significantly increased 3-month mortality, in patients older than 70 years with hematologic disease and an elevated C-reactive protein ( 198 ). The results emphasize that awareness of the eosinophil count is a diagnostic clue in the management of hypereosinophilic patients to reduce diagnostic delay, especially of the underlying malignancy ( 8 , 198 ) ( Figure 2 ).…”

“…In contrast to this, the observation of an increase in eosinophils in a differential count of blood or other samples can be a key piece of information that should be contextualized in advance in the individual (adult) patient. However, a structured approach is required to guide diagnostic and therapeutic decisions clinically, and the task is to isolate the impact of an increased eosinophil count (eosinophilia) from all other etiologic factors in the overall assessment (3)(4)(5)(6)(7)(8).…”

“…Secondary or reactive eosinophilia is driven, in particular, by the cytokine interleukin (IL)-5, produced by activated T lymphocytes (15,16). This scenario of immunological crosstalk is associated with autoimmune, infectious, and inflammatory diseases; malignancy; and allergy, including iatrogenic, drug-induced adverse reactions (3)(4)(5)(6)(7)(8). When no congenital, clonal, or reactive cause can be demonstrated, patients with persistent eosinophil counts of at least 1.5 × 10 9 /L are categorized as idiopathic hypereosinophilic.…”

“…When no congenital, clonal, or reactive cause can be demonstrated, patients with persistent eosinophil counts of at least 1.5 × 10 9 /L are categorized as idiopathic hypereosinophilic. This group can be subdivided into patients with no manifestations of eosinophilia [iHE, or hypereosinophilia of undetermined significance (iHE US )] or idiopathic hypereosinophilic syndrome (iHES), when organ involvement due to eosinophils is present (3)(4)(5)(6)(7)(8)(17)(18)(19)(20). However, the overlap of symptoms, regardless of whether the cause of the disease is primary, secondary, or idiopathic eosinophilia-or a combination of them-is considerable, and characterizes the patient with an increased eosinophil count in blood as a clinical challenge.…”

Challenges in Diagnosis and Management of Unusual Cases of Eosinophilic Enteritis in Rural Health Settings: A Comprehensive Review

“…This observation suggests a potential need for more awareness in non-teaching hospitals and rural settings [10]. Additionally, the escalating incidence of patients with incidental eosinophilia in clinical practice underscores the persistent challenge of diagnosing and effectively treating these conditions [21]. Rectifying this lack of awareness necessitates concerted efforts in education and the formulation of comprehensive diagnostic guidelines.…”