Birch pollen sensitization with cross-reactivity to food allergens predominates in adults with eosinophilic esophagitis

Abstract

EoE patients show variable sensitization patterns to food and aeroallergens. The value of allergy testing in adult EoE patients is unclear. Component-resolved diagnosis (CRD) may offer additional insights into sensitization patterns. The aim of this study was to characterize sensitization patterns in adult EoE patients using CRD. Serum from 76 patients (17 female), age 38.6 ± 1.5 years, was analyzed for reactivity to 112 different allergen components using an immuno-solid-phase allergen chip (ISAC). We observed any sensitization in 59 patients (78%), of which 54 patients were polysensitized. Aeroallergen sensitization, mostly against components of grass or tree pollen, or house dust mite, was observed in 74% of the patients. Birch pollen (rBet v 1) sensitization with cross-reactivity to food allergen components was observed in 30 patients (39%). In conclusion, food sensitizations in EoE patients are mainly caused by cross-reactivity to food allergens after primary birch pollen sensitization. Pollen and food sensitizations may cause or maintain esophageal inflammation in EoE patients. CRD provides more insight into sensitization patterns, identifies additional food allergen sensitizations and might be useful to direct dietary therapy in EoE.

Eosinophilic Esophagitis

“…6,24 Whereas food antigens are primarily identified as the allergic triggers, inhaled aeroallergens have also been implicated in some patients; this finding may represent a manifestation of cross-sensitization to food allergens. 25 Indeed, murine models of eosinophilic esophagitis can be induced by sensitizing and challenging mice with aeroallergens and ovalbumin 26,27 or by overexpressing the cytokines seen in human eosinophilic esophagitis in the animals. 28 Several lines of evidence suggest that interleukin-5 and interleukin-13 may play a role in the pathogenesis of eosinophilic esophagitis.…”

Letter: dietary therapy in eosinophilic oesophagitis – do not test, just eliminate and reintroduce the most common food triggers. Authors' reply

“…2 This counters previous assertions that cross -sensitisation to birch pollen explains food antigenicity in EoE. 11 Dedicated studies using endoscopic sampling following high concentration aero-antigen exposure may resolve this issue.…”

A Role for Pathogenesis-Related Proteins in Poly-Sensitized Allergic Patients with Eosinophilic Esophagitis: Clinical and Endoscopic Features

“…Some authors reported that most EoE patients are sensitized to aeroallergens that cross-react with food allergens. In particular, sensitization to profilins and pathogenesis-related protein 10 (PR-10) is very common [11,12], but their significance is very different. In fact, profilins are ubiquitary allergens with an insignificant clinical role, while for PR-10 the relationship with symptoms is acknowledged.…”

“…These molecules, once digested by pepsin, are degraded in the stomach, but are intact when passing through the esophagus, where they can be recognized by the immune system. Van Rhijn et al reported that sensitization to birch pollen (rBet v1) with cross reactivity to foods via PR-10 protein occurs in 39% of adult EoE patients [12]. On the basis of this feature and the fact that PR-10 proteins occur naturally in many common plant foods, they may play an important role in EoE.…”