Brief Answer:
Reducing eosinophil count is important.

Detailed Answer:
Hi XXXXXXX,
I am Dr. Prakash HM and I would like to help you with your problem.
The abnormal values most important is eosinophils of 39.8%.
TSH is mildly raised and not to be worried for now.
Hemoglobin is within the normal range, So MCV & MCH values just below the normal range might indicate early iron deficiency anemia.
Leukocyte counts are increased primarily due to increased eosinophils.
ESR of 49 mm indicates inflammation. Possibly osteoarthritis of knee along with allergic infection in the lung and is not significant at present.
Knee pain is due to osteoarthritis. It is age related degenerative change in the cartilage surrounding the bone. It is still early stages and can be improved by reducing weight and Vit D, glucosamine and chondroitin sulfate nutritional supplementation. Joint supports and passive exercise to strengthen muscles around joint will also help. If pain increases NSAID painkillers can be taken. As it is early stages, I usually urge my patients to maintain mobility and reduce weight.

Alkaline phosphotase may be elevated due to the bone conditions. Uric acid is mildly elevated and may be due to obesity and is not of much clinical significance.

For me among all the details, eosinophilia is of concern. I need you to get a stool examination to rule out parasitic infections in the gut. If they are present, appropriate treatment should reduce the eosinophil count.
Are there any allergic manifestations? Alerfix will be ideal for it. You can get a serum IgE levels done to check for allergy. However, eosinophil count needs to repeated to recheck the levels after 15 days. If it is reducing, allergy could be the cause. However the allergen needs to be identified.
As there are no other manifestations like fever or breathlessness, I will limit my differentials to the above.

Balanced diet to reduce weight and also nutritionally rich in protein and iron is necessary.

Hope I have answered your questions. Do get the tests done and reducing eosinophil count or identifying cause is paramount. Take care.

Dr. Prakash HM

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Brief Answer:
Avoid wheat & milk for time being.

Detailed Answer:
Hi XXXXXXX
I went through all the reports and am reassured that a cause has been identified. But, it pains to see that allergy is secondary to wheat and milk. Based on my experience, I can comment as follows:
1. Now, for your major problem. As most of your report are within normal limits, we need to reduce the eosinophils first. It is responsible for the burning symptoms. Avoid wheat, milk for time being and continue the drugs, specifically Alerfix.
2. I know it is difficult and completely agree with you regarding avoiding wheat or milk. However, I would suggest you to ask her to avoid it for the time being in any forms. We need to get the eosinophils/ allergic reaction under control.
3. Once, eosinophils comes down to less than 6%, a skin prick allergy test can be performed with wheat proteins and milk proteins for secondary confirmation.
4. Later on, depending on the prior results, we can try procedure called as Elimination diet: Using different variety of wheat or milk and checking for allergic reaction or increased eosinophil count.

The usual treatment methods followed by me are:
1. Allergen avoidance
2. Medications and
3. If both fails, we can try immunomodulators to modify the immune system to accept wheat by increasing wheat in small doses.

This is the standard line of treatment followed everywhere.

Cautions:
1. Risk of severe allergic reaction can be present to wheat predominantly and milk slightly, so its imperative that she avoids them at present in all forms.
2. One more thing I would like to add is there is a possibility of members of family developing allergy, who are directly related to her.
3. Do not rush to add different wheat to the diet. Let her symptoms come down.

Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM

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