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Updated: Aug 26, 2025
Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
Pediatric Eosinophilia: A Review and Multiyear Investigation into Etiologies
Tara E Ness1, Timothy A Erickson2, Veronica Diaz3
1Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Insights
Allergies are the most common cause of pediatric peripheral eosinophilia. This study developed a diagnostic algorithm to aid in evaluating children with high eosinophil counts, especially when the cause is unknown.
Area of Science:
- Pediatric Hematology
- Allergy and Immunology
- Clinical Diagnostics
Background:
- Peripheral eosinophilia is a common finding in children, but its etiology can be challenging to determine.
- Understanding the causes of eosinophilia is crucial for appropriate diagnosis and management in pediatric patients.
Approach:
- A retrospective chart review was conducted on 771 pediatric patients with peripheral eosinophilia.
- Patients were classified by eosinophilia severity: mild, moderate, and severe (based on absolute eosinophil count).
- Diagnostic workup data and patient demographics were collected to identify common etiologies.
Key Points:
- Allergy was the leading cause of pediatric peripheral eosinophilia (46%), primarily atopy and drug reactions.
- Unknown etiology accounted for 36% of cases, with many lacking adequate follow-up.
- Infectious causes (9%) and eosinophilic disorders (6%) were less common.
Conclusions:
- This study identifies key etiologies of pediatric peripheral eosinophilia in a large cohort.
- A diagnostic algorithm is proposed to guide the evaluation and management of pediatric eosinophilia.
- Further research into unknown causes and improved diagnostic strategies are warranted.
Objectives:
To identify the etiology of peripheral eosinophilia in a large pediatric population and to develop a diagnostic algorithm to help guide diagnosis and management of peripheral eosinophilia in the outpatient pediatric population.
Study Design:
We performed a retrospective chart review of children presenting to Texas Children's Hospital in Houston with peripheral eosinophilia between January 1, 2011 and December 31, 2019. Eosinophilia was classified as mild (absolute eosinophil count [AEC] >500 and <1500 cells/μL), moderate (AEC >1500 and <4500 cells/μL), or severe (AEC >4500 cells/μL). Demographic information and diagnostic workup data were collected.
Results:
A total of 771 patients aged <18 years were evaluated. The most common cause of eosinophilia was allergy (n = 357; 46%), with atopy (n = 296) and drug reaction (n = 54) the most common subcauses. This was followed by unknown etiology (n = 274; 36%), infectious causes (n = 72; 9%), and eosinophilic disorders (n = 47; 6%). Many patients with an unknown cause (n = 202; 74%) had limited or no follow-up testing.
Conclusions:
More information on the etiology of pediatric eosinophilia and workup data could help identify the causes. This study provides important information on the evaluation of eosinophilia in the US pediatric population, including a diagnostic algorithm to guide primary care pediatricians.
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