Clinical and immunological biomarkers in hypereosinophilic syndrome: the second step after diagnostic algorithms

BackgroundIdiopathic hypereosinophilic syndrome currently represents a major unmet need for all medical specialties dealing with this disease. Markers capable of characterising the wide variability of its clinical presentation are currently lacking.ObjectiveThis study aims to evaluate a panel of pos...

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Main Authors: David Longhino, Ilaria Baglivo, Maria Antonietta Zavarella, Stefania Colantuono, Chiara Laface, Gabriele Lucca, Laura Bruno, Fabio Romano Selvi, Vincenzo Patella, Aikaterini Detoraki, Rosa Buonagura, Caterina Tatarelli, Barbara Moscatelli, Serena D’Avelli, Elisabetta Abruzzese, Elisabetta Greco, Antonio Gasbarrini, Livio Pagano, Marianna Criscuolo, Sabrina Giammarco, Cristiano Caruso
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Medicine
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Online Access:https://www.frontiersin.org/articles/10.3389/fmed.2025.1600728/full
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author David Longhino
Ilaria Baglivo
Maria Antonietta Zavarella
Stefania Colantuono
Chiara Laface
Gabriele Lucca
Laura Bruno
Fabio Romano Selvi
Vincenzo Patella
Aikaterini Detoraki
Rosa Buonagura
Caterina Tatarelli
Barbara Moscatelli
Serena D’Avelli
Elisabetta Abruzzese
Elisabetta Greco
Antonio Gasbarrini
Livio Pagano
Marianna Criscuolo
Sabrina Giammarco
Cristiano Caruso
author_facet David Longhino
Ilaria Baglivo
Maria Antonietta Zavarella
Stefania Colantuono
Chiara Laface
Gabriele Lucca
Laura Bruno
Fabio Romano Selvi
Vincenzo Patella
Aikaterini Detoraki
Rosa Buonagura
Caterina Tatarelli
Barbara Moscatelli
Serena D’Avelli
Elisabetta Abruzzese
Elisabetta Greco
Antonio Gasbarrini
Livio Pagano
Marianna Criscuolo
Sabrina Giammarco
Cristiano Caruso
author_sort David Longhino
collection DOAJ
description BackgroundIdiopathic hypereosinophilic syndrome currently represents a major unmet need for all medical specialties dealing with this disease. Markers capable of characterising the wide variability of its clinical presentation are currently lacking.ObjectiveThis study aims to evaluate a panel of possible markers in idiopathic hypereosinophilic syndrome.MethodsIn this pilot prospective single-centre cohort study, we analysed clinical (age, years of disease, steroid therapy) and laboratory (absolute eosinophil count, total IgE antibodies, IgE antibodies against Staphylococcus aureus enterotoxins, serum eosinophil cationic protein, serum immunoglobulin free light chains k and λ and their ratio) data obtained from 21 patients suffering from idiopathic hypereosinophilic syndrome from June 2023 to December 2024.ResultsMean absolute eosinophilic count was 3758.57 cells/μL. 17 patients were receiving treatment with > 7.5 mg of prednisone or equivalent at the time of the diagnosis. 13 patients had positive Staphylococcus aureus enterotoxins IgE, while the mean total serum IgE was 241.64 kU/L. We observed a high serum eosinophil cationic protein value as well as a high serum κ free light chain, while serum λ and κ/λ were normal. Patients with higher absolute eosinophilic count had higher eosinophil cationic protein levels (p < 0.05), such as higher steroid consumption (p < 0.05). In addition, we found a strong association between high κ free light chain levels and high previous steroid use and with Staphylococcus aureus enterotoxins IgE positivity.ConclusionOur results could increase the number of possible biomarkers for risk stratification in idiopathic hypereosinophilic syndrome.
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spelling doaj-art-6d2313c0d8794df0a05ddcdeb03fddec2025-08-20T03:29:10ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-07-011210.3389/fmed.2025.16007281600728Clinical and immunological biomarkers in hypereosinophilic syndrome: the second step after diagnostic algorithmsDavid Longhino0Ilaria Baglivo1Maria Antonietta Zavarella2Stefania Colantuono3Chiara Laface4Gabriele Lucca5Laura Bruno6Fabio Romano Selvi7Vincenzo Patella8Aikaterini Detoraki9Rosa Buonagura10Caterina Tatarelli11Barbara Moscatelli12Serena D’Avelli13Elisabetta Abruzzese14Elisabetta Greco15Antonio Gasbarrini16Livio Pagano17Marianna Criscuolo18Sabrina Giammarco19Cristiano Caruso20UOSD Allergology and Clinical Immunology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, Rome, ItalyUOSD Allergology and Clinical Immunology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, Rome, ItalyCentre for Digestive Diseases (CEMAD) and Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, ItalyUOSD DH Internal Medicine and Digestive Disease, Fondazione Policlinico A. Gemelli, IRCCS, Rome, ItalyUOSD Allergology and Clinical Immunology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, Rome, ItalyUOSD Allergology and Clinical Immunology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, Rome, ItalyUOSD Allergology and Clinical Immunology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, Rome, ItalyUOSD Allergology and Clinical Immunology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, Rome, ItalyDivision of Allergy and Clinical Immunology, Department of Medicine, “Santa Maria della Speranza” Hospital, Salerno, ItalyDivision of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity University of Naples Federico II, Naples, ItalyDivision of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity University of Naples Federico II, Naples, ItalyDepartment of Hematology, S. Andrea Hospital, Rome, ItalyDepartment of Internal Medicine, Gemelli Isola, Rome, ItalyASL Frosinone, Pneumology Unit, Frosinone, ItalyHematology, Sant’Eugenio Hospital, Tor Vergata University, Rome, Italy0UOC Reumatologia, Dipartimento di Medicina dei Sistemi, Università di Roma “Tor Vergata”, Rome, ItalyCentre for Digestive Diseases (CEMAD) and Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy1Department of Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy1Department of Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy1Department of Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, ItalyUOSD Allergology and Clinical Immunology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, Rome, ItalyBackgroundIdiopathic hypereosinophilic syndrome currently represents a major unmet need for all medical specialties dealing with this disease. Markers capable of characterising the wide variability of its clinical presentation are currently lacking.ObjectiveThis study aims to evaluate a panel of possible markers in idiopathic hypereosinophilic syndrome.MethodsIn this pilot prospective single-centre cohort study, we analysed clinical (age, years of disease, steroid therapy) and laboratory (absolute eosinophil count, total IgE antibodies, IgE antibodies against Staphylococcus aureus enterotoxins, serum eosinophil cationic protein, serum immunoglobulin free light chains k and λ and their ratio) data obtained from 21 patients suffering from idiopathic hypereosinophilic syndrome from June 2023 to December 2024.ResultsMean absolute eosinophilic count was 3758.57 cells/μL. 17 patients were receiving treatment with > 7.5 mg of prednisone or equivalent at the time of the diagnosis. 13 patients had positive Staphylococcus aureus enterotoxins IgE, while the mean total serum IgE was 241.64 kU/L. We observed a high serum eosinophil cationic protein value as well as a high serum κ free light chain, while serum λ and κ/λ were normal. Patients with higher absolute eosinophilic count had higher eosinophil cationic protein levels (p < 0.05), such as higher steroid consumption (p < 0.05). In addition, we found a strong association between high κ free light chain levels and high previous steroid use and with Staphylococcus aureus enterotoxins IgE positivity.ConclusionOur results could increase the number of possible biomarkers for risk stratification in idiopathic hypereosinophilic syndrome.https://www.frontiersin.org/articles/10.3389/fmed.2025.1600728/fulleosinophils - immunologyfree light chain (FLC)HESbiomarkersECP
spellingShingle David Longhino
Ilaria Baglivo
Maria Antonietta Zavarella
Stefania Colantuono
Chiara Laface
Gabriele Lucca
Laura Bruno
Fabio Romano Selvi
Vincenzo Patella
Aikaterini Detoraki
Rosa Buonagura
Caterina Tatarelli
Barbara Moscatelli
Serena D’Avelli
Elisabetta Abruzzese
Elisabetta Greco
Antonio Gasbarrini
Livio Pagano
Marianna Criscuolo
Sabrina Giammarco
Cristiano Caruso
Clinical and immunological biomarkers in hypereosinophilic syndrome: the second step after diagnostic algorithms
Frontiers in Medicine
eosinophils - immunology
free light chain (FLC)
HES
biomarkers
ECP
title Clinical and immunological biomarkers in hypereosinophilic syndrome: the second step after diagnostic algorithms
title_full Clinical and immunological biomarkers in hypereosinophilic syndrome: the second step after diagnostic algorithms
title_fullStr Clinical and immunological biomarkers in hypereosinophilic syndrome: the second step after diagnostic algorithms
title_full_unstemmed Clinical and immunological biomarkers in hypereosinophilic syndrome: the second step after diagnostic algorithms
title_short Clinical and immunological biomarkers in hypereosinophilic syndrome: the second step after diagnostic algorithms
title_sort clinical and immunological biomarkers in hypereosinophilic syndrome the second step after diagnostic algorithms
topic eosinophils - immunology
free light chain (FLC)
HES
biomarkers
ECP
url https://www.frontiersin.org/articles/10.3389/fmed.2025.1600728/full
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