Eosinophils play a homeostatic role in the body\'s immune responses. These cells are involved in combating some parasitic, bacterial, and viral infections and certain cancers and have pathologic roles in diseases including asthma, chronic rhinosinusitis with nasal polyps, eosinophilic gastrointestinal disorders, and hypereosinophilic syndromes. Treatment of eosinophilic diseases has traditionally been through nonspecific eosinophil attenuation by use of glucocorticoids. However, several novel biologic therapies targeting eosinophil maturation factors, such as interleukin (IL)-5 and the IL-5 receptor or IL-4/IL-13, have recently been approved for clinical use. Despite the success of biologic therapies, some patients with eosinophilic inflammatory disease may not achieve adequate symptom control, underlining the need to further investigate the contribution of patient characteristics, such as comorbidities and other processes, in driving ongoing disease activity. New research has shown that eosinophils are also involved in several homeostatic processes, including metabolism, tissue remodeling and development, neuronal regulation, epithelial and microbiome regulation, and immunoregulation, indicating that these cells may play a crucial role in metabolic regulation and organ function in healthy humans. Consequently, further investigation is needed into the homeostatic roles of eosinophils and eosinophil-mediated processes across different tissues and their varied microenvironments. Such work may provide important insights into the role of eosinophils not only under disease conditions but also in health. This narrative review synthesizes relevant publications retrieved from PubMed informed by author expertise to provide new insights into the diverse roles of eosinophils in health and disease, with particular emphasis on the implications for current and future development of eosinophil-targeted therapies.

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The eosinophil has long been associated with diseases of acute hypersensitivity and with parasite infections, but its exact role in the pathogenesis of these conditions remains uncertain. Characterization of factors associated with migration of eosinophils into tissues has helped to elucidate eosinophil function. Eosinophil chemotactic factors associated with acute hypersensitivity reactions include the eosinophil chemotactic factors of anaphylaxis, histamine, and arachidonic acid metabolites, all of which are released from mast cells, and the lymphokine eosinophil stimulation promoter (ESP). Eosinophilotaxins associated with parasitic diseases include the lymphokine ESP and the low molecular weight factor ECF-G, both associated with schistosome infection in mice. In addition, in several parasite infections parasite-derived protein eosinophil chemotactic factors have been identified and characterized. The proteins associated with Ascaris, Anisakis, and Schistosoma infections appear to be distinct from one another. We have recently partially characterized a protein from Taenia taeniaeformis larvae which has marked chemotactic activity for eosinophils. In addition we have demonstrated eosinophil chemotactic activity associated with metabolism of arachidonic acid by T. taeniaeformis metacestodes. The results of studies in taeniasis and other parasite infections, therefore, indicate that parasite-derived factors may directly influence migration of eosinophils.