Food Allergies/High eosinophils count in a 3 month old
QUESTION: Hello, Dr. Pearson
My 3 months old breast fed baby had a CBC where eosinophils count was 12 as opposed to maximum 5-7% and esr 15 mm/hr. i believe all the other parameters were normal. Also about a month ago we noticed a bump on his leg, that doesn't bother him. We live oversees and our pediatrician sent us to a surgeon who eventually sent us to see a dermatologist. The dermatologist suspected that the bump was an allergic reaction. We went to the allergy doctor who was very concerned about the eos count, prescribed antihistamine and a strict diet for me. Is it really an allergy? He has no other symptoms and is a happy baby otherwise. Should i worry about high eos? Does my diet really matter? Also our doctor postponed all vaccinations. Is it necessary? What would you recommend we do? Or maybe the results I've mentioned are really ok for a 3 month old and I shouldn't worry. Thank you. Diana
ANSWER: Firstly an ESR of only 15 is a positive indication of the Absence of any serious inflammatory disease. That's a good reason for not getting too worried.
It is the absolute numbers of is most important not the percentage of eosinophils in the blood. There are many reasons to have a relative eosinophilia. By far and away commonest cause in a child is the Atopic Syndrome (the inherited tendency to get allergies). It occurs in up to 1/3rd of all children, many, but not all, of whom will suffer from an allergy to something at some time.
Mum;s tend to worry unnecessarily about everything, doctors can worry about blood tests in the same way. I am of the school that avoids sticking a needle into a happy well child and thus avoiding a cause of needless worry. If it ain't bust don't fix it, is my motto.
Of course, the second most common cause is intestinal worms. Always worth checking a simple stool sample. They are surprisingly common even in the most respectable of households. You do not say which "Overseas". In some of them, worm eggs are common even in the soil and sand of popular tourist beaches. But depending on where you are and the sound of the rash on his leg, could it be a tick bite? Those can commonly produce single lesions on a leg which takes a while for the inflammation to settle and can leave a small bump. That could also explain an eosinophilia. Get back to me if you are still unhappy.
I would not worry about the eo's. It does not mean that either of you
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QUESTION: Thank you so much, Dr. Pearson. What you say completely makes sense to me. Right now we live in Russia. I looked up tick bites on internt and don't think they look similar to what he has on his leg. I will check for worms just in case evn though It sounds more like atopic syndrome. My husband has a strong seasonal allergy and our daughter was once diagnosed with atopic dermatitis.
Do you think I need to correct my diet anyway and postpone vaccinations?
Again, thank you for your advice. It's very very helpful.
There is a small risk of increased side effects with some live-virus vaccines, but no mere as great as not being vaccinated. My grandmother had 9 children. Seven died because routine vaccination of children was not then routine. We sometimes forget what life (and death) was like before modern preventative medicine. All I can say is: If it were my child I'd vaccinate (and did despite her atopic eczema).
With a bilaeral familly history, there is an 87% chance that each of your children will be atopc. So? Your husband can live with it. Is that so bad? Can be a darned nuisance at times, that's true, but most of us lead normal healthy lives.
If both you and your child are otherwise well, I'm not too sure what the purpose of you being on a diet will do. It is not something I would necessarilly recommend. To be fair, there are different views on this. The evidence is, that children with a strong familly history of atopy, get less manifestations early in life if for the first 3 months they are purely fed human milk. There is no hard evidence that dietary restriction later than that reduces new manifestations. By far and away the best advice about a child of this age is a non-restictive, wide and varied diet. Get the energy, vitamins, minerals into a growing baby. Good eating early in life is every bit as important as good parenting is. It affects the rest of their lives.