Dichotomy of food and inhalant allergen sensitization in eosinophilic esophagitis

Sugnanam, Kirthi Kumar; Collins, Joel; Smith, Peter; Connor, Frances; Lewindon, Peter; Cleghorn, G. J.; Withers, Geoffrey D.

doi:10.1111/j.1398-9995.2007.01454.x

Cited by 106 publications

(54 citation statements)

References 19 publications

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“…In a pediatric EoE cohort, sensitizations to food and environmental allergens have been observed in 75% and 79%, respectively (11). Skin prick testing in children with EoE revealed increasing reactivity with inhalant allergen with age, while the reactivity to foods decreased (12). Children with EoE were mainly sensitized to milk, eggs, soy, wheat/rye, beef and peanuts (13).…”

Section: Eoe-associated Ige Sensitization To Food and Aeroallergensmentioning

confidence: 99%

Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity

Simon

Cianferoni

Spergel

et al. 2016

Allergy

200

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Eosinophilic esophagitis (EoE) is a chronic disease characterized clinically by symptoms of esophageal dysfunction and histologically by eosinophil-predominant inflammation. EoE is frequently associated with concomitant atopic diseases and immunoglobulin E (IgE) sensitization to food allergens in children as well as to aeroallergens and cross-reactive plant allergen components in adults. Patients with EoE respond well to elemental and empirical food elimination diets. Recent research has, however, indicated that the pathogenesis of EoE is distinct from IgE-mediated food allergy. In this review, we discuss the individual roles of epithelial barrier defects, dysregulated innate and adaptive immune responses, and of microbiota in the pathogenesis of EoE. Although food has been recognized as a trigger factor of EoE, the mechanism by which it initiates or facilitates eosinophilic inflammation appears to be largely independent of IgE and needs to be further investigated. Understanding the pathogenic role of food in EoE is a prerequisite for the development of specific diagnostic tools and targeted therapeutic procedures.Abbreviations ACD, allergic contact dermatitis; AD, atopic dermatitis; APT, atopy patch test; DHR, drug hypersensitivity reactions; EoE, eosinophilic esophagitis; FPIES, food protein-induced enterocolitis; GERD, gastroesophageal reflux disease; GI, gastrointestinal; IBD, inflammatory bowel disease; Ig, immunoglobulin; OAS, oral allergy syndrome; PPI-REE, proton pump inhibitor-responsive esophageal eosinophilia; SFED, six-food elimination diet; SPT, skin prick test; TCR, T-cell receptor; TNF, tumor necrosis factor.Allergy 71 (2016) 611-620

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Section: Eoe-associated Ige Sensitization To Food and Aeroallergensmentioning

confidence: 99%

Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity

Simon

Cianferoni

Spergel

et al. 2016

Allergy

200

130

View full text Add to dashboard Cite

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“…According to current guidelines, EoE is defined as a chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by esophageal infiltration with at least 15 eosinophils per high-power field(HPF) (6,7). Immune reactions to food antigens, and in some cases maybe also to aeroalergens, are regarded to play crucial role in its development (6,8,9). For confirming a diagnosis of EoE, other diseases that may result in esophageal eosinophilia, especially GERD, should be excluded.…”

Section: Introductionmentioning

confidence: 99%

Development of urinary incontinence in a 7-year old boy after therapy with proton pump inhibitors and complete resolution of his clinicopathologic features of eosinophilic esophagitis after H2-receptor antagonist treatment: A case report

2017

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Ključne besede:gastroezofagealna refluksna bolezen; otrok; inhibitorji protonske črpalke; H2-blokatorji; eozinofilni ezofagitis; na inhibitor protonske črpalke odzivna ezofagealna eozinofilija Development of urinary incontinence in a 7-year old boy after therapy with proton pump inhibitors and complete resolution of his clinicopathologic features of eosinophilic esophagitis after H2-receptor antagonist treatment: A case report Klinični primer razvoja urinske inkontinence pri 7-letnem fantu med zdravljenjem z inhibitorjem protonske črpalke in izginotje kliničnopatoloških znakov eozinofilnega ezofagitisa po zdravljenju z antagonisti H2 receptorjev AbstractBackground: Several diseases result in profound infiltration of esophageal mucosa by eosinophilic granulocites, with gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE) and proton-pump-inhibitor-responsive esophageal eosinophilia (PPI-REE) being the most prevalent. Proton-pump-inhibitor-responsive esophageal eosinophilia (PPI-REE) is a newly recognized entity that must be differentiated from eosinophilic esophagitis (EoE).Case presentation: A 7-year old Slovenian male presented with a few-month history of chest pain, regurgitation and heartburn. First endoscopy was performed and revealed pronounced longitudinal furrows, and on hystology examination > 70 eosinophils per high power field were found through the entire thickness of epithelium and in the submucosis with eosinophilic microabscess formation. Results of 24-hour pH-monitoring (without impedance monitoring) excluded pathologic acid reflux. All allergy tests were negative. The patient started treatment with proton pump inhibitors (PPIs) for three times, twice with pantoprazole before the endoscopy and once with esomeprasole after it to exclude the diagnosis of GERD and PPI-REE. Urinary incontinence reappeared each time just few days after starting treatment and disapeared few days after stopping it. Therefore, urinary incontinence was considered as a plausible adverse effect of therapy with PPIs. As treatment with PPIs was not tolerated, a therapy with H2-receptor antagonists ranitidine was applied for more than 2 months followed by a second endoscopy. Both symptoms and esophageal eosinophilia completely resolved with ranitidine. The resolution of esophageal eosinophilia in PPI-REE has been atributed to proton pump independent antiinflammatory effects of PPIs. No such effects have been described in H2-receptor antagonists. Conclusions:Two unique phenomena were observed in the pediatric patient with profound esophageal eosinophilia: urinary incontinence as an adverse effect of therapy with PPIs, and complete resolution of esophageal eosinophilic inflammation with typical features of EoE after treatment with H2-receptor antagonists. IzvlečekIzhodišča: Mnoge bolezni lahko privedejo do obsežne infiltracije sluznice požiralnika z eozinofilnimi granulociti. Med njimi so najbolj pogoste gastroezofagealna refluksna bolezen, eozinofilni ezofagitis in na inhibitor protonske črpalke odzivna ezofag...

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“…D'autre part, les éosinophiles sont un composant important de l'inflammation liée à l'EoE, et sont aussi impliquésd ans la plupart des maladies allergiques classiques IgE-dépendantes. On trouved onc très souvent dans la littérature l'EoE présentéec omme une allergie alimentaire, ce qui fait que, consciemment ou non, les communautés médicale et scientifique ont rapidement dressé des analogies entre l'EoE et d'autres phénomènes de sensibilité immédiate telles que rhinite et asthme allergiques, ou allergies alimentaires « classiques ».Or, si on considère par exemple l'étude de régime alimentaire empirique mentionnéec i-dessus, seulement 10 %d es patients montraient un test allergologique cutané positif pour un ou plusieurs des aliments [23] ; à noter que d'autres études plus anciennes montraient des fréquences plus élevées [24,25]. Une fréquence plus élevéee st aussi retrouvées il et est cutané d'hypersensibilité immédiate est combinéà un atopyp atch-test [26].…”

Section: Etiologie Et Pathogénieunclassified

La mystérieuse œsophagite à éosinophiles garde encore quelques secrets

Vicari¹

2017

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Dichotomy of food and inhalant allergen sensitization in eosinophilic esophagitis

Abstract: In children with EE, the sensitization to inhalant allergens increases with age, particularly after 4 years. Also, specific enquiry about severe food reactions in patients presenting with EE is strongly recommended as it appears this patient group has a high incidence of anaphylaxis.

Cited by 106 publications

References 19 publications

Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity

Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity

Development of urinary incontinence in a 7-year old boy after therapy with proton pump inhibitors and complete resolution of his clinicopathologic features of eosinophilic esophagitis after H2-receptor antagonist treatment: A case report

La mystérieuse œsophagite à éosinophiles garde encore quelques secrets

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