Eosinophilic Esophagitis and IgG4: Is There a Relationship?

Lim, Amanda; Wong, Stephanie; Nguyen, Nam Q.

doi:10.1007/s10620-020-06788-0

Cited by 18 publications

(26 citation statements)

References 91 publications

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“…Meta-analysis has demonstrated that elevation in IgG 4 subclass is related to ASD. Although commonly associated IgG4-related disease, such as fibro-inflammatory changes in the salivary and lacrimal glands, orbit, pancreas, and kidneys [87] is not common for children with ASD, elevated IgG4 is associated with eosinophilic esophagitis [88], a disorder that is under diagnosed and associated with restricted feeding in ASD [89]. This raises the possibility that IgG4 could potentially be used to help differentiate children with feeding disorders due to eosinophilic esophagitis and behavioral issues.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Immunoglobulin G Abnormalities and the Therapeutic Use of Intravenous Immunoglobulins (IVIG) in Autism Spectrum Disorder

Rossignol¹,

Frye

2021

JPM

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Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting approximately 2% of children in the United States. Growing evidence suggests that immune dysregulation is associated with ASD. One immunomodulatory treatment that has been studied in ASD is intravenous immunoglobulins (IVIG). This systematic review and meta-analysis examined the studies which assessed immunoglobulin G (IgG) concentrations and the therapeutic use of IVIG for individuals with ASD. Twelve studies that examined IgG levels suggested abnormalities in total IgG and IgG 4 subclass concentrations, with concentrations in these IgGs related to aberrant behavior and social impairments, respectively. Meta-analysis supported possible subsets of children with ASD with low total IgG and elevated IgG 4 subclass but also found significant variability among studies. A total of 27 publications reported treating individuals with ASD using IVIG, including four prospective, controlled studies (one was a double-blind, placebo-controlled study); six prospective, uncontrolled studies; 2 retrospective, controlled studies; and 15 retrospective, uncontrolled studies. In some studies, clinical improvements were observed in communication, irritability, hyperactivity, cognition, attention, social interaction, eye contact, echolalia, speech, response to commands, drowsiness, decreased activity and in some cases, the complete resolution of ASD symptoms. Several studies reported some loss of these improvements when IVIG was stopped. Meta-analysis combining the aberrant behavior checklist outcome from two studies demonstrated that IVIG treatment was significantly associated with improvements in total aberrant behavior and irritability (with large effect sizes), and hyperactivity and social withdrawal (with medium effect sizes). Several studies reported improvements in pro-inflammatory cytokines (including TNF-alpha). Six studies reported improvements in seizures with IVIG (including patients with refractory seizures), with one study reporting a worsening of seizures when IVIG was stopped. Other studies demonstrated improvements in recurrent infections, appetite, weight gain, neuropathy, dysautonomia, and gastrointestinal symptoms. Adverse events were generally limited but included headaches, vomiting, worsening behaviors, anxiety, fever, nausea, fatigue, and rash. Many studies were limited by the lack of standardized objective outcome measures. IVIG is a promising and potentially effective treatment for symptoms in individuals with ASD; further research is needed to provide solid evidence of efficacy and determine the subset of children with ASD who may best respond to this treatment as well as to investigate biomarkers which might help identify responsive candidates.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Immunoglobulin G Abnormalities and the Therapeutic Use of Intravenous Immunoglobulins (IVIG) in Autism Spectrum Disorder

Rossignol¹,

Frye

2021

JPM

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“…There is emerging evidence that supports the association of immunoglobulin patterns in EoE. For instance, IgG4 is increased in EoE tissues [72]. Mouse models of EoE demonstrate the ability of B cell-deficient mice to develop EE [73].…”

Section: Pathophysiologymentioning

confidence: 97%

Eosinophilic Esophagitis due to Aeroallergens: A Systematic Review and Update

Gómez¹,

Torrijos²

2022

J Investig Allergol Clin Immunol

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Eosinophilic esophagitis is a chronic antigen-mediated esophageal disease characterized by symptoms related to esophageal dysfunction and histologically by Th2 inflammation (at least15 eosinophils/high power field) when other secondary systemic and local causes of esophageal eosinophilia are excluded. Though this disease was initially ascribed to a delayed reaction to food allergens, emerging evidence suggests that aeroallergens may also play roles in his pathogenesis and evolution. Some studies support seasonal variation in Eosinophilic esophagitis diagnosis and disease exacerbations about the increase in aeroallergens to which patients are sensitized. It is also known that this disease can be generated after an extensive, identifiable aeroallergen exposure and after treatment with specific immunotherapy with food or aeroallergens. Recently, it has been postulated that treatment of allergic rhinoconjunctivitis may improve Eosinophilic esophagitis symptoms, though data is limited to case reports and small series. Currently, biomarkers and biologic therapies are not helpful for diagnosis or inducing clinical and histological remission of the disease. Although there are high hopes for dupilumab This review aims to give visibility to the involvement of aeroallergens in the triggering and exacerbation of eosinophilic esophagitis since many of them, in addition to being in the air and being able to inhale them, can also ingest them as part of the food. It is essential to highlight that we must try to discover the cause of the disease since it is crucial for its remission.

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“…[3][4][5]17 The spectrum of non-IgE mediated CMA includes proctocolitis, food protein induced enteropathy and enterocolitis syndrome and more recently eosinophilic esophagitis has also been recognized as a predominant non-IgE mediated condition with the most recent hypotheses proposing an IgG4 pathophysiology. [18][19][20][21] Food Protein Induced Enterocolitis Syndrome is a non-IgE-mediated food allergy that typically presents in infancy, with repetitive protracted vomiting that begins approximately 1 to 4 hours after food ingestion. Vomiting is often accompanied by lethargy and pallor and can be followed by diarrhea.…”

Section: Symptomsmentioning

confidence: 99%

“… 29 , 30 The possible role for IgG4 in the pathophysiology of eosinophilic esophagitis, primarily a non-IgE mediated disease needs further clarification. 19 The diagnostic contribution of the allergen-specific lymphocyte stimulation test needs to be further evaluated and is not available in routine clinical practice. 29 The Atopy Patch Test has been proposed and appeared promising in non-IgE mediated allergy but has been insufficiently studied and standardized to be recommended by any of the official allergy bodies (including the National Institute of Allergy and Infectious Diseases (NIAID) and European Academy for Allergy and Clinical Immunology (EAACI) guidelines).…”

Section: Diagnosismentioning

confidence: 99%

Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy

Vandenplas¹,

Brough²,

Fiocchi³

et al. 2021

JAA

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Exclusive breast feeding is recommended in all guidelines as the first choice feeding. Cow milk allergy (CMA) can be diagnosed by a diagnostic elimination diet for 2 to 4 weeks with a hypo-allergenic formula, followed by a challenge test with intact cow milk protein. The most often used hypo-allergenic formula for the diagnostic elimination diet and the therapeutic diet is a CM based extensive hydrolysate. CM-based partial hydrolysates cannot be recommended in the management of CMA because of insufficient efficacy and possible reactions, but about half of the infants with CMA may tolerate a partial hydrolysate. The pros and cons of other dietary options are discussed in this paper. The use of an amino acid-based formula and/or rice based hydrolysate formula during the diagnostic elimination and therapeutic diet is debated. When available, there is sufficient evidence to consider rice hydrolysates as an adequate alternative to CM-based hydrolysates, since some infants will still react to the CM hydrolysate. The pros and cons of dietary options such as soy formula, buckwheat, almond, pea or other plant based dietary products are discussed. Although the majority of the plant-based beverages are nutritionally inadequate, some are nutritionally adapted for toddlers. However, accessibility and content vary by country and, thus far there is insufficient evidence on the efficacy and tolerance of these plant-based drinks (except for soy formula and rice hydrolysates) to provide an opinion on them. Conclusion: A diagnostic elimination diet, followed by a challenge remains the diagnostic standard. The use of an awareness tool may result in a decrease of delayed diagnosis. Breastmilk remains the ideal source of nutrition and when not available a CM extensively hydrolyzed formula, rice hydrolysate or amino acid formula should be recommended. More evidence is needed regarding plant-based drinks.

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Eosinophilic Esophagitis and IgG4: Is There a Relationship?

Cited by 18 publications

References 91 publications

A Systematic Review and Meta-Analysis of Immunoglobulin G Abnormalities and the Therapeutic Use of Intravenous Immunoglobulins (IVIG) in Autism Spectrum Disorder

A Systematic Review and Meta-Analysis of Immunoglobulin G Abnormalities and the Therapeutic Use of Intravenous Immunoglobulins (IVIG) in Autism Spectrum Disorder

Eosinophilic Esophagitis due to Aeroallergens: A Systematic Review and Update

Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy

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