Eosinophilic Esophagitis due to Aeroallergens: A Systematic Review and Update

Abstract

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.

Impact of environmental factors on the epidemiology of eosinophilic esophagitis in southwestern Europe (2007-2020)

“…The frequency of EoE triggered by occupational aeroallergens in patients with occupational allergy respiratory disease is 8%, and the frequency in patients with esophageal dysfunction symptoms and occupational allergy respiratory disease is 57%. 12 …”

Plant and Arthropod IgE-Binding Papain-like Cysteine Proteases: Multiple Contributions to Allergenicity

“…In reality, in addition to food proteins, every protein known as inhaled allergen can also be ingested ( Figure 2 ) and vice versa—some food allergenic proteins ( Figure 1 ) can be inhaled [ 35 , 59 , 60 ]. For instance, it is possible for pollen allergens to be ingested in foods such as honey or in periods of pollination [ 61 , 62 , 63 , 64 , 65 ]. However, mite proteins, including the PLCP Der p 1 and its homologs, can be also ingested [ 28 , 66 ].…”

Eosinophilic esophagitis – discussion of the current state of knowledge and new possibilities for biological treatment

“…Ponad połowa pacjentów z EZP ma dodatni wywiad rodzinny w kierunku chorób alergicznych [2]. Nasilenie objawów u części chorych jest obserwowane wiosną i jesienią, kiedy większa jest ekspozycja na alergeny w powietrzu [1,[8][9][10][11]. Zjawisko to dotyczy pacjentów, u których obserwujemy alergie/atopie na antygeny wziewne.…”