Eosinophilic esophagitis with extremely high esophageal eosinophil counts

O’Shea, Kelly; Rochman, Mark; Shoda, Tetsuo; Zimmermann, Nives; Caldwell, Julie M.; Rothenberg, Marc E.

doi:10.1016/j.jaci.2020.05.045

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…258 An extreme EoE phenotype combines very high eosinophils with allergic multimorbidities and some of the genes found in asthma, rhinitis, and AD multimorbidities. 94…”

Section: Eosinophilic Esophagitismentioning

confidence: 99%

Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA‐MeDALL hypothesis

Bousquet

Melén

Haahtela

et al. 2023

Allergy

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Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease," coined over 20 years ago, is a simplistic approach of the links between upper-and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper-and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis." This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis, and conjunctivitis.

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“…258 An extreme EoE phenotype combines very high eosinophils with allergic multimorbidities and some of the genes found in asthma, rhinitis, and AD multimorbidities. 94…”

Section: Eosinophilic Esophagitismentioning

confidence: 99%

Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA‐MeDALL hypothesis

Bousquet

Melén

Haahtela

et al. 2023

Allergy

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“…111,112 In a registry of EoE patients, O'shea et al compared patients with high-grade esophageal eosinophilia (>350 eosinophils per hpf) to patients with low-grade eosinophilia (15-24 eosinophils per hpf) and found statistically significant differences in histologic severity, endoscopic severity and gene expression but not symptoms. 113 The mechanisms by which eosinophils drive histopathologic features of EoE are not fully elucidated. Eosinophils possess granules that consist of cytotoxic proteins including eosinophil peroxidase (EPX), major basic protein (MBP), eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN).…”

Section: The Eosinophil Eotaxin Subfamily and Il-5mentioning

confidence: 99%

“…Eosinophil numbers can be significant with micro‐abscesses and esophageal eosinophilia correlates with histopathologic features (including DIS and BZH) and disease severity 111,112 . In a registry of EoE patients, O'shea et al compared patients with high‐grade esophageal eosinophilia (>350 eosinophils per hpf) to patients with low‐grade eosinophilia (15–24 eosinophils per hpf) and found statistically significant differences in histologic severity, endoscopic severity and gene expression but not symptoms 113 …”

Section: Immunological Processesmentioning

confidence: 99%

“… 111 , 112 In a registry of EoE patients, O'shea et al compared patients with high‐grade esophageal eosinophilia (>350 eosinophils per hpf) to patients with low‐grade eosinophilia (15–24 eosinophils per hpf) and found statistically significant differences in histologic severity, endoscopic severity and gene expression but not symptoms. 113 …”

Section: Immunological Processesmentioning

confidence: 99%

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Eosinophilic esophagitis: Immune mechanisms and therapeutic targets

Khokhar

Marella

Idelman

et al. 2022

Clin Experimental Allergy

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Eosinophilic esophagitis (EoE) is an emerging chronic inflammatory disease of the oesophagus characterized by upper gastrointestinal (GI) symptoms including dysphagia and esophageal food impaction. 1,2 The histopathological manifestations involve intraepithelial infiltration of eosinophils (≥15 Eos/HPF) and remodelling of the esophageal epithelium including basal zone hyperplasia (BZH) and dilated intercellular spaces (DIS), which can lead to strictures and narrow-caliber oesophagus. 3,4

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“…As shown in Table 1, eosinophils produce and release various mediators that are involved in inflammation, immunoregulation, and tissue remodeling and repair. In EoE, levels of tissue eosinophilia correlate with disease severity as well as response to treatments (156,164). On the other hand, eosinophils clearly have a homeostatic or physiologic role as resident cells in the rest of the GI tract and findings from EoE-like disease along with the limited effectiveness of anti-IL-5 therapy suggest a minor role in clinical symptoms in EoE.…”

Section: Roles Of Eosinophils In Eoementioning

confidence: 99%

Eosinophils in Eosinophilic Esophagitis: The Road to Fibrostenosis is Paved With Good Intentions

et al. 2020

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Eosinophilic esophagitis (EoE) is an antigen-driven disease associated with epithelial barrier dysfunction and chronic type 2 inflammation. Eosinophils are the defining feature of EoE histopathology but relatively little is known about their role in disease onset and progression. Classically defined as destructive, end-stage effector cells, eosinophils (a resident leukocyte in most of the GI tract) are increasingly understood to play roles in local immunity, tissue homeostasis, remodeling, and repair. Indeed, asymptomatic esophageal eosinophilia is observed in IgE-mediated food allergy. Interestingly, EoE is a potential complication of oral immunotherapy (OIT) for food allergy. However, we recently found that patients with peanut allergy may have asymptomatic esophageal eosinophilia at baseline and that peanut OIT induces transient esophageal eosinophilia in most subjects. This is seemingly at odds with multiple studies which have shown that EoE disease severity correlates with tissue eosinophilia. Herein, we review the potential role of eosinophils in EoE at different stages of disease pathogenesis. Based on current literature we suggest the following: (1) eosinophils are recruited to the esophagus as a homeostatic response to epithelial barrier disruption; (2) eosinophils mediate barrier-protective activities including local antibody production, mucus production and epithelial turnover; and (3) when type 2 inflammation persists, eosinophils promote fibrosis.

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Eosinophilic esophagitis with extremely high esophageal eosinophil counts

Cited by 8 publications

References 15 publications

Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA‐MeDALL hypothesis

Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA‐MeDALL hypothesis

Eosinophilic esophagitis: Immune mechanisms and therapeutic targets

Eosinophils in Eosinophilic Esophagitis: The Road to Fibrostenosis is Paved With Good Intentions

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