Abstract
We have studied a patient with recurrent bouts of angioedema, myalgia, and eosinophilia that was not due to L-tryptophan ingestion. Peripheral blood eosinophils (EOSs) during exacerbations of his illness displayed characteristics of "activation," including hypodense phenotype and increased responsiveness to platelet-activating factor (PAF) in vitro with respect to expression of CD11b surface adhesion proteins. Elevated serum levels of granulocyte-macrophage colony-stimulating factor (GM-CSF) bioactivity were also detected, whereas interleukin-3 and interleukin-5 levels were not increased. During treatment with glucocorticoids, all clinical symptoms resolved, EOSs decreased in number and became normodense, PAF responsiveness diminished, and GM-CSF levels returned to normal. During glucocorticoid tapering, a subsequent clinical relapse was again associated with EOS hypodensity, increased PAF responsiveness, and increased serum GM-CSF levels. Although this patient satisfies the diagnostic criteria for eosinophilia-myalgia syndrome, the episodic and profound nature of exacerbations and response to therapy in the absence of L-tryptophan usage suggests a possible overlap with the syndrome of episodic angioedema and eosinophilia. In vitro studies suggest that GM-CSF may play a role in the eosinophilia, EOS activation, and pathophysiology of disease in this patient and demonstrate resolution of these abnormalities during glucocorticoid therapy. The efficacy of glucocorticoid therapy in some hypereosinophilic states may therefore be mediated, at least in part, via reduction of GM-CSF production and / or EOS activation.
Original language | English (US) |
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Pages (from-to) | 629-636 |
Number of pages | 8 |
Journal | The Journal of allergy and clinical immunology |
Volume | 88 |
Issue number | 4 |
DOIs | |
State | Published - Oct 1991 |
Funding
From the Department of Medicine, Division of Clinical Im-munology., Johns Hopkins Asthma and Allergy Center, Balti-more, Md. Supported by National Institutes of Health Grants A127429, A108270, and A120136. Received for publication Jan. 30, 1991. Revised May 6, 1991. Accepted for publication May 22, 1991. Reprint requests: Bruce S. Bochner, MD, Johns Hopkins Asthma and Allergy Center, Clinical Immunology Unit Office 3, 301 Bayview Blvd., Baltimore, MD 21224.
Keywords
- Eosinophil activation
- GM-CSF
- myalgia
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology