Clinical nephrologyClinical nephrologyКлиническая нефрология2075-35942414-9322Bionika Media70406410.18565/nephrology.2026.1.69-80Literature ReviewsОбзоры литературыReview ArticleEosinophilic diseases: classification, clinical and pathogenetic relationships, and an algorithmic approach to diagnosisЭозинофильные заболевания: классификация, клинико-патогенетические взаимосвязи, алгоритмический подход к диагностикеhttps://orcid.org/0000-0002-6086-5220FrolovaNadiya F.ФроловаНадия Фяатовна
Russian Federation

Dr.Sci. (Med.), Deputy Chief Physician for Nephrology Care, Head of the Interdistrict Nephrology Center, Moscow Clinical Research Center, Hospital No. 52, Moscow Healthcare Department; Associate Professor, Department of Nephrology, Faculty of Continuous Professional Education, Russian University of Medicine

д.м.н., заместитель главного врача по нефрологической помощи, руководитель межокружного нефрологического центра, Государственное бюджетное учреждение здравоохранения города Москвы «Московский клинический научно-исследовательский центр Больница 52 Департамента здравоохранения города Москвы»; доцент кафедры нефрологии факультета дополнительного профессионального образования ФГБОУ ВО «Российский университет медицины» Минздрава РФ

nadiya.frolova@yandex.ruhttps://orcid.org/0000-0002-7771-4074VolginaGalina V.ВолгинаГалина Владимировна
Russian Federation

Dr.Sci. (Med.), Professor, Department of Nephrology, Faculty of Continuous Professional Education

д.м.н., профессор кафедры нефрологии факультета дополнительного профессионального образования

volginagv@mail.ruhttps://orcid.org/0000-0002-5083-6637FominaDaria S.ФоминаДарья Сергеевна
Russian Federation

Dr.Sci. (Med.), Professor, Deputy Director for Research and Clinical Work, Moscow Clinical Research Center, Hospital No. 52, Moscow Healthcare Department; Chief External Expert in Allergology and Immunology of the Moscow Healthcare Department; Professor, Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University (Sechenov University)

д.м.н., профессор, заместитель директора по научно-клинической работе, Государственное бюджетное учреждение здравоохранения города Москвы «Московский клинический научно-исследовательский центр Больница 52 Департамента здравоохранения города Москвы»; главный внештатный специалист аллерголог-иммунолог ДЗМ, профессор кафедры клинической иммунологии и аллергологии ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава РФ (Сеченовский университет)

daria_fomina@mail.ruhttps://orcid.org/0000-0002-4949-9178KruglovaTatyana S.КругловаТатьяна Сергеевна
Russian Federation

Head of the Allergology and Immunology Department

заведующая отделением аллергологии и иммунологии

surckova.t@yandex.ruhttps://orcid.org/0000-0002-8742-3860UsatyukSergey S.УсатюкСергей Сергеевич
Russian Federation

Head of Nephrology Department No. 2

заведующий 2-м нефрологическим отделением

usatuk-doc@mail.ruhttps://orcid.org/0000-0003-2850-4465IskhakovRustam T.ИсхаковРустам Тимурович
Russian Federation

Head of the Intensive Care Department for Nephrological Patients

заведующий отделением реанимации и интенсивной терапии для пациентов нефрологического профиля помощи

stamius@yandex.ruhttps://orcid.org/0000-0001-5809-6015MutovinaZinaida Yu.МутовинаЗинаида Юрьевна
Russian Federation

Cand.Sci. (Med.), Deputy Chief Physician for Medical Affairs, Moscow Clinical Research Center, Hospital No. 52, Moscow Healthcare Department; Associate Professor at the Department of Therapy, Cardiology, and Functional Diagnostics with a Course in Nephrology, Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation

к.м.н., заместитель главного врача по медицинской части Государственное бюджетное учреждение здравоохранения города Москвы «Московский клинический научно-исследовательский центр Больница 52 Департамента здравоохранения города Москвы»; доцент кафедры терапии, кардиологии и функциональной диагностики ФГБУ «ДПО» ЦГМА УД Президента РФ с курсом нефрологии

zmutovina@mail.ruMoscow Clinical Research Center, Hospital No. 52ГБУЗ «Московский клинический научно-исследовательский центр больница № 52 Департамента здравоохранения города Москвы»Russian University of MedicineФГБОУ ВО «Российский университет медицины» Минздрава РФSechenov First Moscow State Medical University (Sechenov University)ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава РФ (Сеченовский университет)Central State Medical Academy of the Administrative Directorate of the President of the Russian FederationФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ1103202618169801003202610032026Copyright ©; 2026, Bionika MediaCopyright ©; 2026, ООО «Бионика Медиа»2026Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/2075-3594/article/view/704064

This literature review focuses on current understanding of eosinophil-associated diseases – a heterogeneous group of conditions united by a common feature: an increased number of eosinophils in the blood and/or tissues. This article systematizes current information on the classification, pathogenesis, and diagnosis of eosinophilia, hypereosinophilia (HE), and hypereosinophilic syndrome (HES). It is emphasized that an increased eosinophil count per se is not a diagnosis, but rather a symptom that can be primary (clonal), secondary (reactive), or idiopathic. The clinical manifestations of HE are polymorphic and can affect various organs, necessitating a multidisciplinary approach. The diagnostic algorithm discussed in this review is based on the sequential exclusion of conditions that are common causes of secondary HES, the search for clonality (hematological neoplasms), and a mandatory comprehensive assessment of target organ damage. Accurately determining the type of HES in accordance with current consensus classifications (WHO, ICOG-EO) is the cornerstone for selecting a personalized therapeutic strategy and determining the prognosis.

Обзор литературы посвящен современным представлениям об эозинофил-ассоциированных заболеваниях – гетерогенной группе состояний, объединенных общим признаком – повышением числа эозинофилов в крови и/или тканях. В работе систематизированы актуальные сведения о классификации, патогенезе и диагностике эозинофилии, гиперэозинофилии (ГЭ) и гиперэозинофильного синдрома (ГЭС). Подчеркивается, что само по себе повышение числа эозинофилов не является диагнозом, а служит симптомом, который может быть первичным (клональным), вторичным (реактивным) или идиопатическим. Клинические проявления ГЭ полиморфны и могут затрагивать различные органы, что определяет необходимость междисциплинарного подхода. Диагностический алгоритм, рассматриваемый в обзоре, основан на последовательном исключении состояний – частых причин вторичных ГЭ, поиске клональности (гематологические новообразования) и обязательной комплексной оценке поражения органов-мишеней. Точное установление типа ГЭС в соответствии с современными консенсусными классификациями (ВОЗ, ICOG-EO) является краеугольным камнем для выбора персонализированной терапевтической стратегии и определения прогноза заболевания.

eosinophilic diseaseseosinophiliahypereosinophiliahypereosinophilic syndromeclassificationpathogenesistarget organ damagediagnostic algorithmэозинофильные заболеванияэозинофилиягиперэозинофилиягиперэозинофильный синдромклассификацияпатогенезпоражение органов-мишенейдиагностический алгоритмShomali W., Gotlib J. World Health Organization and international consensus classification of eosinophilic disorders: 2024 update on diagnosis, risk stratification, and management. Am. J. Hematol. 2024;99:946–68. Doi: 10.1002/ajh.27287.Valent P., Klion A.D., Roufosse F. et al. Proposed refined diagnostic criteria and classification of eosinophil disorders and related syndromes. Allergy. 2023;78(1):47–59. Doi: 10.1111/all.15544.Thomsen G.N., Christoffersen M.N., Lindegaard H.M. et al. The multidisciplinary approach to eosinophilia. Front. Oncol. 2023;13:1193730. Doi: 10.3389/fonc.2023.1193730.Marichal T., Mesnil C., Bureau F. Homeostatic Eosinophils: Characteristics and Functions. Front. Med. 2017;4:101. Doi: 10.3389/ fmed.2017.00101.Weller P.F., Spencer L.A. Functions of tissue-resident eosinophils. Nat. Rev. Immunol. 2017;17(12):746–60. Doi: 10.1038/nri.2017.95.Klion A.D., Ackerman S.J., Bochner B.S. Contributions of Eosinophils to Human Health and Disease. Annu. Rev. Pathol. 2020;15:179–209. Doi: 10.1146/annurev-pathmechdis-012419-032756.Mormile M., Mormile I., Fuschillo S. et al. Eosinophilic Airway Diseases: From Pathophysiological Mechanisms to Clinical Practice. Int. J. Mol. Sci. 2023;24(8):7254. Doi: 10.3390/ijms24087254.Wechsler M.E., Munitz A., Ackerman S.J. et al. Eosinophils in Health and Disease: A State-of-the-Art Review. Mayo Clin. Proc. 2021;96(10):2694–707. Doi: 10.1016/j.mayocp.2021.04.025.Taurisano G., Ruffi M.C., Canalis S., Costanzo G.A.M.L. Hypereosinophilia: clinical and therapeutic approach in 2025. Curr. Opin. Allergy Clin. Immunol. 2025;25(4):258–68. Doi: 10.1097/ACI.0000000000001078.Caminati M., Brussino L., Carlucci M. et al. Managing patients with hypereosinophilic syndrome: a statement from the Italian Society of Allergy. Asthma Clin. Immunol. Cells. 2024;13(14):1180. Doi: 10.3390/ cells13141180.Valent P., Gleich G.J., Reiter A. et al. Pathogenesis and classification of eosinophil disorders: a review of recent developments in the field. Expert. Rev. Hematol. 2012;5(2):157–76. Doi: 10.1586/ehm.11.81.Wang S.A., Orazi A., Gotlib J. et al. The international consensus classification of eosinophilic disorders and systemic mastocytosis. Am. J. Hematol. 2023;98(8):1286–306. Doi: 10.1002/ajh.26966.Klion A.D. Eosinophilia: a pragmatic approach to diagnosis and treatment. Hematology Am. Soc. Hematol. Educ. Program. 2015;2015(1):92–7. Doi: 10.1182/asheducation-2015.1.92.Simon H.U., Rothenberg M.E., Bochner B.S. et al. Refining the definition of hypereosinophilic syndrome. J. Allergy Clin. Immunol. 2010;126(1):45–9. Doi: 10.1016/j.jaci.2010.03.042.Valent P., Klion A.D., Horny H.P. et al. Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes. J. Allergy Clin. Immunol. 2012;130(3):607–12. Doi: 10.1016/j.jaci.2012.02.019.Shomali W., Gotlib J. Eosinophils and their disorders. Williams Hematology. Ed. by K. Kaushansky, J.T. Prchal, L.J. Burns, et al. 10th ed. New York: McGraw Hill, 2021.Tzankov A., Reichard K.K., Hasserjian R.P. et al. Updates on eosinophilic disorders. Virchows Arch. 2023;482:85–97. Doi: 10.1007/s00428-022-03402-8.O’Connell E.M., Nutman T.B. Eosinophilia in Infectious Diseases. Immunol. Allergy Clin. North Am. 2015;35(3):493–522. Doi: 10.1016/j.iac.2015.05.003.Decruyenaere P., Van de Maele B., Hulstaert E. et al. IgE-mediated gastroallergic anisakiasis with eosinophilic oesophagitis: A case report. Acta Clin. Belg. 2022;77(1):396–9. Doi: 10.1080/17843286.2020.1822627.Okumura K., Kubota T., Lefor A.K., et al. Increased number of eosinophils in ascites is associated with intestinal anisakidosis. J. Helminthol. 2019;93(1):126–9. Doi: 10.1017/S0022149X17001158.Molina B., Padoan R., Urban M.L. et al. Dupilumab for Relapsing or Refractory Sinonasal and/or Asthma Manifestations in Eosinophilic Granulomatosis With Polyangiitis: A European Retrospective Study. Ann. Rheum. Dis. 2023;82(12):1587–93. Doi: 10.1136/ ard-2023-224756.Olaguibel J.M., Sastre J., Rodríguez J.M., Del Pozo V. Eosinophilia Induced by Blocking the IL-4/IL-13 Pathway: Potential Mechanisms and Clinical Outcomes. J. Invest. Allergol. Clin. Immunol. 2022;32(3):165–80. Doi: 10.18176/jiaci.0823.Rauscher C., Freeman A. Drug-induced eosinophilia. Allergy Asthma Proc. 2018;39(3):252–6. Doi: 10.2500/aap.2018.39.4120.Perkins C., Wills-Karp M., Finkelman F.D. IL-4 induces IL-13-independent allergic airway inflammation. J. Allergy Clin. Immunol. 2006;118(2):410–9. Doi: 10.1016/j.jaci.2006.06.004.Cabanas R., Ramirez E., Sendagorta E. et al. Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome. J. Investig. Allergol. Clin. Immunol. 2020;30(4):229–53. Doi: 10.18176/jiaci.0480.Calle A.M., Aguirre N., Ardila J.C., Cardona Villa R. DRESS syndrome: A literature review and treatment algorithm. W. Allergy Organ. J. 2023;16:100673. Doi: 10.1016/j.waojou.2022.100673.Khoury P., Akuthota P., Kwon N. et al. HES and EGPA: Two Sides of the Same Coin. Mayo Clin. Proc. 2023;98(7):1054–70. Doi: 10.1016/ j.mayocp.2023.02.013.Strobel M.J., Alves D., Roufosse F. et al. Insights from social media on the patient experience of living with rare eosinophil-driven diseases. J. Patient Exp. 2022;9:23743735221143953. Doi: 10.1177/23743735221143953.Wardlaw A.J., Wharin S., Aung H. et al. The causes of a peripheral blood eosinophilia in a secondary care setting. Clin. Exp. Allergy. 2021;51(7):902–14. Doi: 10.1111/cea.13889.Helbig G., Klion A.D. Hypereosinophilic syndromes – an enigmatic group of disorders with an intriguing clinical spectrum and challenging treatment. Blood Rev. 2021;49:100809. Doi: 10.1016/j.blre.2021.100809.Valent P., Degenfeld-Schonburg L., Sadovnik I. et al. Eosinophils and eosinophil-associated disorders: immunological, clinical, and molecular complexity. Semin. Immunopathol. 2021;43(3):423–38. Doi: 10.1007/ s00281-021-00863-y.Caminati M., Carpagnano L.F., Alberti C. et al. Idiopathic hypereosinophilic syndromes and rare dysimmune conditions associated with hyper-eosinophilia in practice: An innovative multidisciplinary approach. W. Allergy Organ. J. 2024;17(8):100928. Doi: 10.1016/j.waojou.2024.100928.Klion A.D. Approach to the patient with suspected hypereosinophilic syndrome. Hematology Am. Soc. Hematol. Educ. Program. 2022;2022(1):47–54. Doi: 10.1182/hematology.2022000367.Requena G., van den Bosch J., Akuthota P. et al. Clinical profile and treatment in hypereosinophilic syndrome variants: a pragmatic review. J. Allergy Clin. Immunol. Pract. 2022;10(8):2125–34. Doi: 10.1016/ j.jaip.2022.03.034.Ogbogu P.U., Bochner B.S., Butterfield J.H. et al. Hypereosinophilic syndrome: a multicenter, retrospective analysis of clinical characteristics and response to therapy. J. Allergy Clin. Immunol. 2009;124(6):1319–25.e3. Doi: 10.1016/ j.jaci.2009.09.022.Radonjic-Hoesli S., Brüggen M.C., Feldmeyer L. et al. Eosinophils in skin diseases. Semin. Immunopathol. 2021;43(3):393–409. Doi: 10.1007/ s00281-021-00868-7.Balaskas K., Wyss P., Guex-Crosier Y. Ocular involvement in idiopathic hypereosinophilic syndrome: a rare finding. Klin. Monbl. Augenheilkd. 2012;229(4):437–8. Doi: 10.1055/s-0031-1299176.Tamaki H., Chatterjee S., Langford C.A. Eosinophilia in Rheumatologic/Vascular Disorders. Immunol Allergy Clin North Am. 2015;35(3):453–76. Doi: 10.1016/j.iac.2015.05.001.Ihn H. Eosinophilic fasciitis: From pathophysiology to treatment. Allergol. Int. 2019;68(4):437–9. Doi: 10.1016/j.alit.2019.03.001.Bay P., Groh M., Gaillet A., et al. Extracorporeal membrane oxygenation for refractory acute eosinophilic pneumonia. J. Crit. Care. 2024;79:154437. Doi: 10.1016/j.jcrc.2023.154437.Soma S. Pericardial effusion and progressive bilateral effusion as rare presentations of idiopathic hypereosinophilic syndrome. Cureus. 2023;15(8):e44495. Doi: 10.7759/cureus.44495.Dong J.H., Xu S.T., Xu F. et al. Clinical and morphologic spectrum of renal involvement in idiopathic hypereosinophilic syndrome. Clin. Exp. Nephrol. 2021;25(3):270–8. Doi: 10.1007/s10157-020-02012-5.Ono R., Iwahana T., Kato H. et al. Literature reviews of stroke with hypereosinophilic syndrome. Int. J. Cardiol. Heart Vasc. 2021;37:100915. Doi: 10.1016/j.ijcha.2021.100915.Bondue A., Carpentier C., Roufosse F. Hypereosinophilic syndrome: considerations for the cardiologist. Heart. 2022;108(3):164–71. Doi: 10.1136/heartjnl-2020-317202.Réau V., Vallée A., Terrier B. et al. Venous thrombosis and predictors of relapse in eosinophil-related diseases. Sci. Rep. 2021;11(1):6388. Doi: 10.1038/s41598-021-85852-9.Podjasek J.C., Butterfield J.H. Mortality in hypereosinophilic syndrome: 19 years of experience at Mayo Clinic with a review of the literature. Leuk. Res. 2013;37(4):392–5. Doi: 10.1016/j.leukres.2012.12.005.Emmi G., Bettiol A., Gelain E. et al. Evidence-Based Guideline for the Diagnosis and Management of Eosinophilic Granulomatosis With Polyangiitis. Nat. Rev. Rheum. 2023;19(6):378–93. Doi: 10.1038/s41584-023-00958-w.Hellmich B., Sanchez-Alamo B., Schirmer J.H. et al. EULAR Recommendations for the Management of ANCA-Associated Vasculitis: 2022 Update. Ann. Rheum. Dis. 2024;83(1):30–47. Doi: 10.1136/ard-2022-223764.Chung S.A., Langford C.A., Maz M. et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Arthr. Care Res. 2021;73(8):1088–105. Doi: 10.1002/acr.24634.Wechsler M.E., Akuthota P., Jayne D. et al. Mepolizumab or Placebo for Eosinophilic Granulomatosis With Polyangiitis. N. Engl. J. Med. 2017;376(20):1921–32. Doi: 10.1056/NEJMoa1702079.FDA, FDA Prescriping Information (Nucala) accessed October 5, 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/ 125526s007lbl.pdf.Wechsler M., Kovalszki A., Silver J. et al. Pulmonary Function and Asthma Control in Patients With Eosinophilic Granulomatosis With Polyangiitis or Hypereosinophilic Syndrome and Comorbid Asthma Treated With Mepolizumab. Chest. 2024;166(45):28A. Doi: 10.1016/ j.chest.2024.06.048.Wechsler M.E., Akuthota P., Jayne D. et al. Mepolizumab or Placebo for Eosinophilic Granulomatosis With Polyangiitis. N. Engl. J. Med. 2017;376(20):1921–32. Doi: 10.1056/NEJMoa1702079.Wechsler M.E., Silver J., Wolff G. et al. Long-Term Safety and Efficacy of Mepolizumab in Eosinophilic Granulomatosis With Polyangiitis. Arthr. Rheumatol. 2025;77(8):1052–62. Doi: 10.1002/art.43146.Pongdee T., Deb A., Silver J. et al. Mepolizumab Reduces Systemic Corticosteroid (SCS)-Related Toxicities Compared to Chronic SCS Use in Patients With EGPA. J. Allergy Clin. Immunol. 2025;155(2):AB455. Doi: 10.1016/j.jaci.2024.12.1055.Bettiol A., Urban M.L., Dagna L. et al. Mepolizumab for Eosinophilic Granulomatosis With Polyangiitis: A European Multicenter Observational Study. Arthr. Rheumatol. 2022;74(2):295–306.Ishii T., Kunishige H., Kobayashi T. et al. Real-World Safety and Effectiveness of Mepolizumab for Patients With Eosinophilic Granulomatosis With Polyangiitis in Japan: Long-Term Observation of the MARS Study. Mod. Rheumatol. 2024;34(5):978–87. Doi: 10.1093/mr/roae100. PMID: 39508562.Kitamura N., Hamaguchi M., Nishihara M. et al. The Effects of Mepolizumab on Peripheral Circulation and Neurological Symptoms in Eosinophilic Granulomatosis With Polyangiitis (EGPA) Patients. Allergol. Intern. 2021;70(1):148–9. Doi: 10.1016/j.alit.2020.08.005.Yamane T., Hashiramoto A. Mepolizumab Exerts Crucial Effects on Glucocorticoid Discontinuation in Patients With Eosinophilic Granulomatosis With Polyangiitis: A Retrospective Study of 27 Cases at a Single Center in Japan. Arthr. Res. Ther. 2023;25(1):110.6. Doi: 10.1186/s13075-023-03097-5.Rios-Garces R., Prieto-Gonzalez S., Hernandez-Rodriguez J. et al. Response to Mepolizumab According to Disease Manifestations in Patients With Eosinophilic Granulomatosis With Polyangiitis. Eur. J. Int. Med. 2022;95:61–6. Doi: 10.1016/j.ejim.2021.08.021.Wechsler M.E., Nair P., Terrier B. et al. Benralizumab Versus Mepolizumab for Eosinophilic Granulomatosis With Polyangiitis. N. Engl. J. Med. 2024;390(10):911–21. Doi: 10.1056/NEJMoa2311155.Wechsler M.E., Agmon-Levin N., Jayne D.R.W. et al. Discontinuation of Oral Glucocorticoids and Achievement of Remission in Patients With Eosinophilic Granulomatosis With Polyangiitis Treated With Benralizumab or Mepolizumab. ACR Open Rheumatol. 2025;7(9):e70096. Doi:10.1002/acr2.70096.Biddle K., Jade J., Wilson-Morkeh H. et al. The 2025 British Society for Rheumatology Management Recommendations for ANCA-Associated Vasculitis. Rheumatol. (Oxford, England). 2025;64(8):4470–94. Doi: 10.1093/rheumatology/keaf474.Manka L.A., Guntur V.P., Denson J.L. et al. Efficacy and Safety of Reslizumab in the Treatment of Eosinophilic Granulomatosis With Polyangiitis. Ann. Allergy Asthma Immunol. 2021;126(6):696–701.e691. Doi: 10.1016/ j.anai.2021.01.035.ClinicalTrials.gov. NCT05263934: Efficacy and Safety of Depemokimab Compared With Mepolizumab in Adults With Relapsing or Refractory Eosinophilic Granulomatosis With Polyangiitis (EGPA) (OCEAN), accessed December 16, 2025. https://clinicaltrials.gov/study/ NCT05263934.Menzies-Gow A., Corren J., Bourdin A. et al. Tezepelumab in Adults and Adolescents With Severe, Uncontrolled Asthma. N. Engl. J. Med. 2021;384(19):1800–9. Doi: 10.1056/ NEJMoa2034975.Lipworth B.J., Han J.K., Desrosiers M. et al. Tezepelumab in Adults With Severe Chronic Rhinosinusitis With Nasal Polyps. N. Engl. J. Med. 2025;392(12):1178–88. Doi: 10.1056/NEJMoa2414482.