Eosinophilic granulomatosis with polyangiitis across the eosinophilic spectrum: from molecular mechanisms to practical differential diagnosis and targeted therapy
Year: 2025
Type: article
Abstract: Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis defined by asthma, hypereosinophilia, and multiorgan involvement. Differentiating EGPA from other eosinophilic disorders is crucial because management differs substantially. The aim of the study is to summarize the pathogenesis, epidemiology, genetics, clinical manifestation, and treatment of EGPA and to provide a comparative differential diagnosis of eosinophilic disorders. Material and methods: Narrative review using the 2022 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria, 2024 EULAR recommendations, pivotal randomized trials, and major consensus statements; search strategy and selection criteria are detailed in the Introduction. Results: Eosinophilic granulomatosis with polyangiitis comprises 2 immunologic endotypes - ANCA-positive and ANCA-negative - with distinct organ tropism and therapeutic implications. The interleukin-5 (IL-5)-eosinophil axis is central, supporting anti-IL-5/IL-5R biologics in relapsing or refractory disease. A structured differential first excludes secondary hypereosinophilia (parasites, drugs, malignancies) and then addresses pulmonary "mimics". Conclusions: An algorithm combining exclusion of secondary causes with organ and endotype profiling enables targeted therapy and reduced glucocorticosteroids exposure.
Source: Reumatologia/Rheumatology
DOI: 10.5114/reum/214426
Authors: Aleksandra Hus, Małgorzata Wisłowska
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7116669397