Dr. Hive

[wapiti]

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[Reefgazer]

I really don't know the answer to your question, except that low neutrophils can be caused by autoimmune disorders, which fits in with your son's immune issues (asthma, allergies are both immune-related).  OTOH, it can be caused by vitamin deficiencies, also, and given that he is a picky eater, you ought to keep track of his vitamin intake to rule that out.  So based on those 2 factors, I'd be leaning to your second choice, with the idea in the back of my head that it could be caused by the combination of autoimmune issues and vitamin deficiency.

 

Question:  Please don't take this as being critical, I am just genuinely curious about the strep infection that went untreated.  I'm assuming it was untreated because you didn't realize it was strep.  Every time my DD has strep, it presents with a high fever, which makes it obvious because she's miserable.  Did your DS not have symptoms?  I know that's possible because some people are carriers and never present with symptoms, which I guess may be the answer to my nosy question.

[wapiti]

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[Tiramisu]

wapiti, why is it when I read your posts I often get a deja vu feeling?

 

I have a dd with low IgA. She's the one who has always had stomach issues and constipation, but no lung issues or obvious allergies. She had inflammation in her stomach identified by a biopsy. She's the only one who hasn't been tested for allergies lately. She had repeated bouts with strep as a child and did not present normally at all. She would throw up in the middle of the night. 

 

Low IgA will affect the lungs and GI system because I believe it's related to the secretions and the immunity of those systems. It will make them more likely to pick up things. My dd is low and is always flagged on bloodwork but not to the point where the doctors make an issue of it. I think in those cases you will see numbers close to zero. 

 

This dd is also the one who is being watched for the auto-immune disease because she has elevated levels of some auto-antibodies.

 

One thing about her is that her tonsils are huge, so large that they were noted on an MRI report. She has not had a problem with growth or weight, and has tons of bloodwork but never high neutrophils. 

[kroe1]

Poor growth in a child with high eosinophils would make me think of parasites.

[Tiramisu]

Popping back to say that people with low IgA are more prone to autoimmune disorders from what I remember.

[Tiramisu]

wapiti, sbgrace has a ds with low IgA. She may be able to help you.

[ChemMommy]

Glad you are seeing an allergist/immunologist.....BUT, if you don't get good answers, please search for someone who does immunology work as the majority of their practice.  DD14 has low IgA, low IgG, complement disorders, etc.  Took a long time to get the right treatment. She was not growing at all before treatment.  Please prepare for a long wait to get the right answer; there may be some attempts at treatments and more tests before they narrow it down. So much is not known about the immune system.  I'd call to get on a cancellation list, but our last appointment was a 3 month wait. (she wasn't critically sick, though).

[Nemom]

http://pandasnetwork.org/pandas/

 

Check out the above link. Symptoms sound like Pediatric Autoimmune Illness Associated with Strep (PANDAS). Dd was dx'd with this 5 years ago. She is one those kids who does not present with a fever when she has strep or even a sore throat. Her ASO numbers were 1200 when we finally figured out what was going on. Sudden on-set OCD is one of the hallmark symptoms. So is eating issues.

 

Tends to run in siblings and often a weak immune system is involved. Some kids go on to be dx'd with chronic Lyme disease as well.

[LMV]

Eosinophilia (abnormally high number of eosinophils in the blood) can be caused by:

-Parasitic infections

-Drug reactions

-Allergies/Asthma/Eczema (generally more modest elevations)

-Adrenal Insufficiency

-Some autoimmune diseases (i.e. Lupus)

-Hypereosinophilic Syndrome  

-Hyper IgE Syndrome (eosinophilia, recurrent infections--especially Staph)

 

Additional Eosinophilia explanations for a child with Asthma:

-Churg-Strauss Syndrome (Vasculitis)

-Allergic Bronchopulmonary Aspergillosis (more of an immune reaction to Aspergillus than an infection--thus steroids not antifungals are first line therapy)

 

The combination of eosinophilia and neutropenia (abnormally low number of neutrophils in the blood) would make me worry more about some kind of malignancy

-Eosinophilic Leukemia (a rare form of AML --can be associated with a hypereosinophilic syndrome but this is much less common in kids)

-Certain Lymphomas

-Chronic Eosinophilic Leukemia (uncommon in children)

 

To answer your questions,

-I think this is unlikely to be related to his brother's Group A Strep.  I will agree that your other son's symptoms do sound like they could represent PANDAS? Did your pediatrician send ASO and anti DNAase B titers? Also, so you don't beat yourself up mercilessly, PANDAS is thought to be caused by the immune reaction to the infection not by the bacteria itself.  At this point there really isn't good evidence that treating strep infections will prevent PANDAS.  Having said that, I do advocate treating all confirmed (by rapid testing or throat culture) Strep pharyngitis because there is good evidence that this can prevent Rheumatic Fever.

-Allergies, asthma, etc can certainly lead to eosinophilia.  This may be the full explanation and if the elevations are very modest then nothing more than getting the best control possible of these conditions may be a very reasonable approach.  I do think it is reasonable to allow your pediatrician or the immunologist to proceed with as much of a workup as they feel is reasonable to eliminate more sinister explanations.  Of course if the eosinophil count is very high then it warrants more of a workup and often specific interventions to reduce this.

 

I hope this helped.  My lists above are much less than complete I'm sure these were just things which came to mind when I thought about it. Good Luck!

[Splash]

My daughter had similar symptoms two summers ago.  She had markers for autoimmune diseases as well. She had strep, trouble breathing, tired, virus after virus.  She is allergic to eggs, corn, wheat, peanuts, tree nuts, and lots of pollens and I swear the whole state of Florida.  She had stomach aches all the time, was tiny (69lbs 4'6" and 11 yrs old) had dropped off the growth curve.  We tested for Celiac, and GI was wondering about Irritable Bowel disease.  Keep seeking answers, if you think something is wrong.  Sometimes I thought maybe I was making too much of her symptoms.  Looking back now I see that it was all leading up to her crash in the fall of that year when she ended up in the PICU with kidney failure.  She ended up having a compliment mediated disease that is an ultra rare genetic disease, so I doubt that is what your son has, but my point is that it was something and worth pursuing answers.  I hope you find answers for your son too.

[wapiti]

Thanks LMV, that's a ton of info!  I really appreciate it.

[Tiramisu]

Thanks LMV, that's a ton of info!  I really appreciate it.

 

 

Ick.  I have no clue about what would be modest vs more significant levels; the EOS were 17% and then went down to 14% (supposed to be less than 5%) and neutrophils improved from 14% to 22% but still under the 30-something percent minimum normal level.  I suppose it's a good sign that the numbers are improving!  (On top of everything, poor kiddo had a stiff neck for a day and a half, seven days after the meningitis vaccine - getting better finally.)

 

 

Thank you!!!  I was hoping it would not be related as I don't want to have to hound someone into testing asthma boy for strep.  *sigh*  PANDAS boy has been keeping me so busy that I haven't had time to read/freak out much about asthma boy.  Unfortunately, our ped office does. not. treat. PANDAS.  "We treat OCD as OCD and strep as strep."  In other words, sudden-onset OCD is not a symptom of strep in their world even though they admit that infections can cause spikes in anxiety-related stuff.  Well la. dee. da.  I paid hundreds of dollars and drove an hour to an "alternative" ped to get the zithromax prescription for him a couple weeks ago after Anti-Dnase B was at 651 and ASO at 889 (tested thanks to our "alternative" nutritionist).  The throat culture from the alternative ped ended up being positive.  Now I'm holding my breath until his cardiology appt on Monday because he's been reporting occasional weird symptoms over the past couple months, e.g., random stabbing, pain while laying on back, etc... Cardiology is awesome as they wasted no time ordering a 30-day monitor to at least look into that.  Hoping it's just another panic/anxiety thing related to the OCD (hoping it's not something with his cardiomyopathy).  However, interestingly, if he did turn out to have pericarditis or fluid or something related to the strep infection, the treatment is probably very close to what I'd be seeking for the PANDAS (make sure the strep is dead and then work against inflammation).

 

That's a lot to worry about. Hang in there, wapiti!

 

My kids with high eos--the younger ones, not my oldest with the autoimmune questions--turned out to have allergies and were given some kind of new asthma test because of it. There lungs were fine but there is a question that eosinophilia is causing their ongoing stomach upset. They have not had any issues with neutrophils. So it could be just the ongoing allergy/asthma issues explaining the high eos part of things in your ds. 

[wapiti]

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[Tiramisu]

I'd go with a very small dose of the appropriate SSRI. It could help and give you and your ds a little relief. Very small doses are unlikely to cause big issues, at least I think so. That's just my feeling, since you have so much going on. I haven't dealt with OCD but from the stories I've heard it can really affect life.

[ocelotmom]

I would ask to see the actual numbers. Specifically, is the neutrophil count actually low, or proportionally low?

 

Lab results often give the white blood cell count as a fraction adding up to 100%. If one type of WBC is elevated, then others are going to be proportionally lower than usual, even if, in terms of total count, they're within normal range. 

 

High eosinophils would be expected given his asthma and allergy issues.

[Guest lora]

Hi, 

 

I have lurked here before but never posted. I have an asthmatic son who is in the bottom 5% for BMI (he is tall, though) and who was failure to thrive as a baby. He was given a battery of tests in the name of trying to figure out why he often complains of stomach pain. Everything came back normal except the eosinophils, which were sky high at 2750. He was allergy tested for food allergies and came back clean. His doc then ordered a round of antiparasitic medication. He seems somewhat better but still complains sometimes. We are supposed to get him retested and then I don't know what. I was interested to see other asthmatic kids with high eos and another child with high eos and stomach pain. Any updates on these kids? 

 

[Tiramisu]

Hi, 

 

I have lurked here before but never posted. I have an asthmatic son who is in the bottom 5% for BMI (he is tall, though) and who was failure to thrive as a baby. He was given a battery of tests in the name of trying to figure out why he often complains of stomach pain. Everything came back normal except the eosinophils, which were sky high at 2750. He was allergy tested for food allergies and came back clean. His doc then ordered a round of antiparasitic medication. He seems somewhat better but still complains sometimes. We are supposed to get him retested and then I don't know what. I was interested to see other asthmatic kids with high eos and another child with high eos and stomach pain. Any updates on these kids? 

 

Hi lora,

 

Is your son being seen by a specialist of esosinophilic disorders? There's a lot of research being done and centers for these problems at major children's hospitals. I'd consider looking into what centers are close to you if you haven't explored that yet since a lot of it is cutting edge. With such a long term issue and the numbers so high, I think I'd want to find someone who is a real specialist in the field.

 

I imagine you would probably want to get an endoscopy to see if the eosinophils are in the esophagus and/or stomach if the problem continues.

 

Our allergist did lung testing to make sure they didn't have eosinophils in their lungs, as I mentioned in my earlier post. Have you had that testing since your son has asthma? It's a machine they breathe into that measures a gas as they exhale. It's different from the one they use for regular asthma testing.

 

Our children had only mildly elevated eosinophils--sometimes high, sometimes normal. We did find things with the allergy testing. One has been consistently better and it could be because she avoids what she knows her triggers are--and her triggers are not everything she is allergic to, only some things. The other is eating recklessly and tends to feel sick often. What is strange about her is that I've noticed she will get a low grade fever with her stomachache. It will last a day or two and then resolve. Sometimes it will last a few days and if she truly miserable, she'll be a bit more careful with her diet until it resolves. It's not a great situation.