Angiolymphoid hyperplasia with eosinophilia treated with anti-interleukin-5 antibody (mepolizumab)

Sir, Angiolymphoid hyperplasia with eosinophilia (ALHE) is an unusual condition that usually manifests in young to middle‐aged caucasian adults as a single pinkish‐brown nodule, several centimetres in size, preferentially at the retroauricular area or as a group of smaller nodules distributed on the head and neck.1 In addition to tissue eosinophilia, some patients may develop peripheral blood eosinophilia and markedly elevated serum IgE levels, features typically seen in Kimura's disease.1 Treatment of ALHE is problematic, as the cause is unknown. Excision may be curative, but is difficult to perform in extensive cases.2 Alternative options including systemic corticosteroids, radiation, laser surgery, cryosurgery, cytotoxic agents and pentoxifylline have been tried with variable responses and relapses after withdrawal.3 As interleukin (IL)‐5, the major cytokine involved in production, mobilization and activation of eosinophils, has been found to be elevated in patients with ALHE,4, 5 blocking the interaction between IL‐5 and its receptor might be a reasonable therapeutic approach.