H pylori infection and lack of association with eosinophilia

Question:

5/6/2017
I recently evaluated a 45-year-old woman who presented with severe abdominal pain after going on an elimination diet to reduce weight. She had eliminated grains, egg and dairy for 3 weeks. When she reintroduced dairy, she developed severe abdominal pain and diarrhea and went to the emergency room. She had a normal CAT scan and was referred to a gastroenterologist. She underwent endoscopy and was diagnosed with H. pylori infection and put on a course of antibiotics with noticeable improvement. Her biopsy was also notable for inflammation of the duodenum with eosinophils up to 100 per high-power field as well as gastritis with eosinophils up to 30 per high-power field. There was no eosinophilic inflammation of the esophagus. Her laboratory evaluation was notable for a normal chemistry profile, thyroid screening, ESR, CRP and celiac serology. Her CBC was abnormal with a white blood cell count of 7.9 and 40% eosinophils for an absolute eosinophil count of 3160.

I did limited prick skin testing and she did not have evidence of IgE-mediated allergy to milk, egg, soy or any of the grains. I am planning on repeating some blood work and additional testing. I would very much appreciate recommendations from our panel of experts.