Documents from the SIAIP Commissions

Issue 1 - 2026

The role of eosinophils in the diagnosis of allergic diseases

Authors

Serena Gracci , Davide Caimmi , Stefani Arasi , Fernanda Chiera , Giulio Dinardo , Arianna Giannetti , Carla Mastrorilli , Luca Pecoraro , Gian Luigi Marseglia , Michele Miraglia Del Giudice , Roberto Bernardini

Key words: eosinophils, allergy diagnosis, drug allergy, food allergy, respiratory allergy, skin allergy
DOI: 10.53151/2531-3916/2026-1744
Publication Date: 2026-03-27

Abstract

Eosinophilic granulocytes are hematopoietic effector cells involved in allergy, infection, chronic inflammation, and some malignancies. Produced in bone marrow, they circulate in blood before migrating to tissues where they release mediators that regulate immune responses and promote inflammation and remodeling. Normally representing about 1% of peripheral leukocytes, eosinophils reflect the balance between bone marrow production, tissue recruitment, and apoptosis. Elevated counts in blood or tissues are associated with diverse conditions. In allergic diseases, eosinophils are key biomarkers. In asthma, blood and airway eosinophilia characterize T2 inflammation, guide therapy, and predict exacerbations, although correlations between blood and tissue levels vary. Eosinophilia is also relevant in chronic rhinosinusitis, food allergies, and eosinophilic gastrointestinal disorders (EGIDs), where tissue-based criteria are essential for diagnosis, especially in eosinophilic esophagitis. In atopic dermatitis, eosinophils correlate with severity, while in urticaria and drug reactions their significance is variable. Drug-induced eosinophilia ranges from benign to severe systemic conditions such as drug reaction with eosinophilia and systemic symptoms. Overall, eosinophilia is a frequent but nonspecific finding, serving as a marker of atopy, disease severity, or treatment response. Tissue eosinophilia, however, is indispensable for diagnosing specific disorders, notably EGIDs and hypereosinophilic syndromes

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Authors

Serena Gracci - Pediatrics and Neonatology Unit, Maternal and Child Department, San Giuseppe Hospital, Empoli, Azienda USL Toscana Centro, Italy

Davide Caimmi - Allergy Unit, CHU de Montpellier, Montpellier, France; IDESP, UMR 1318, INSERM, University of Montpellier, Montpellier, France

Stefani Arasi - Area of Translational Research in Pediatric Specialities, Allergy Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

Fernanda Chiera - Department of Pediatrics, Giovanni Paolo II Hospital, Lamezia Terme, ASP Catanzaro, Italy

Giulio Dinardo - Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli’” Naples, Italy

Arianna Giannetti - Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

Carla Mastrorilli - Department of Pediatrics, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, Bari, Italy

Luca Pecoraro - Pediatric Unit, Ospedale Vito Fazzi, ASL Lecce, Lecce, Italy

Gian Luigi Marseglia - Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy

Michele Miraglia Del Giudice - Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli’” Naples, Italy

Roberto Bernardini - Pediatrics and Neonatology Unit, Maternal and Child Department, San Giuseppe Hospital, Empoli, Azienda USL Toscana Centro, Italy

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Gracci, S., Caimmi, D., Arasi, S., Chiera, F., Dinardo, G., Giannetti, A., Mastrorilli, C., Pecoraro, L., Marseglia, G. L., Miraglia Del Giudice, M., & Bernardini, R. (2026). The role of eosinophils in the diagnosis of allergic diseases. Italian Journal of Pediatric Allergy and Immunology, 40(1), 44–51. https://doi.org/10.53151/2531-3916/2026-1744
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