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March 11, 1968

Eosinophilia In Atopic Disease

JAMA. 1968;203(11):991. doi:10.1001/jama.1968.03140110083030

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To the Editor:—  In the article, "Clinical Aspects of Eosinophilia in Atopic Disease" by Francis C. Lowell, MD (202:875, 1967) two points require discussion.The section Clinical Applications lists five general guides. Number three states that infection is probably absent in patients in asthmatic relapse who show eosinophilia, even when slight elevations of temperature and sedimentation rate occur with a purulent sputum containing large numbers of eosinophils. The fact that such patients may respond to full doses of steroids without antibiotics is beside the point. It has been known from the initial studies with steroids that inflammation in infection may be decreased by steroids; the fact that patients so treated "respond" is thus no evidence that infection is absent. On the contrary, I think most clinicians would agree that elevation of temperature, however slight, and the appearance of purulent sputum with or without eosinophils, should be considered strong clinical