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Updated: Jun 27, 2025
Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
From evidence to practice: A systematic review-based diagnostic algorithm for paediatric eosinophilia across
Roberta Pellegrino1, Mariangela Tosca2, Edoardo Timitilli1
1Department of Health Sciences, University of Florence, Florence, Italy.
Insights
Pediatric eosinophilia causes differ by socioeconomic status. Allergic diseases are common in high-income countries, while parasitic infections prevail in low-income settings. A new algorithm aids diagnosis.
Area of Science:
- Pediatric Hematology
- Clinical Immunology
- Infectious Diseases
Background:
- Pediatric eosinophilia presents a diagnostic challenge, often requiring extensive evaluations.
- Understanding the varied etiologies across different socioeconomic settings is crucial for effective management.
Purpose of the Study:
- To investigate the primary causes of pediatric eosinophilia in diverse socioeconomic environments.
- To develop and propose a practical diagnostic algorithm for children with eosinophilia.
Main Methods:
- A systematic literature review was performed using PubMed, Embase, and the Cochrane Library.
- Studies published between January 2012 and June 2023 on pediatric peripheral eosinophilia were analyzed.
- Data from high-income and low-income countries were compared.
Main Results:
- Fifteen observational studies involving 3409 children were included.
- In high-income countries, allergic diseases (7.7%-78.2%) predominated over parasitosis (1.0%-9.1%).
- In low-income countries, parasitosis (17.7%-88.3%) was more common than allergic diseases (2.5%-4.8%).
- Allergic diseases caused mild-to-moderate eosinophilia; parasitosis was linked to moderate-to-severe cases; immunological disorders were associated with severe eosinophilia.
Conclusions:
- A step-up diagnostic algorithm was developed.
- The algorithm incorporates the child's origin and eosinophilia severity.
- This approach aims to optimize resource allocation in diagnosing pediatric eosinophilia.
Aim:
Paediatric eosinophilia is a common clinical dilemma, often leading to resource- and time-consuming assessments. We aim to evaluate the main aetiologies of eosinophilia in children from different socioeconomic settings and propose a diagnostic algorithm.
Methods:
A systematic literature review was conducted through PubMed, Embase and the Cochrane Library. Studies published from January 2012 to June 2023 reporting the incidence and aetiology of peripheral eosinophilia in children were included. Evidence from studies on children originating from low- or high-income countries was compared.
Results:
A total of 15 observational studies, encompassing 3409 children, were included. The causes of eosinophilia varied based on the children's origin and the eosinophilia severity. In children from high-income countries, allergic diseases were the leading cause, with a prevalence of 7.7%-78.2%, while parasitosis ranged from 1.0% to 9.1%. In children from low-income countries, parasitosis was predominant, ranging from 17.7% to 88.3%, although allergic diseases were found in 2.5%-4.8% of cases. Concerning severity, allergic diseases were the leading cause of mild-to-moderate eosinophilia; parasitosis was associated with moderate-to-severe eosinophilia, while immunological disorders were mostly found in severe cases.
Conclusion:
We developed a step-up diagnostic algorithm that considers the child's origin and eosinophilia severity and could optimise resource allocation.
